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基于“适时”框架的分化型甲状腺癌患者不同阶段疾病体验的定性纵向研究。

Disease Experience of Patients With Differentiated Thyroid Cancer at Different Phases Based on Timing It Right Framework: A Qualitative Longitudinal Study.

机构信息

Author Affiliations: School of Nursing, Nanjing University of Chinese Medicine (Mss Pei, Meng, and Xue); and Department of Nursing, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine (Ms Zhang).

出版信息

Cancer Nurs. 2024;47(5):388-396. doi: 10.1097/NCC.0000000000001233. Epub 2023 Mar 13.

Abstract

BACKGROUND

As the incidence of differentiated thyroid cancer (DTC) continues to rise globally, it is important to gain insight into the disease experience of cancer patients at different phases of the disease. However, surveys addressing the longitudinal disease experience and specific needs of this population are lacking.

OBJECTIVE

The aim of this study was to explore the disease experience of people with DTC at key time points in their cancer trajectory so support can be rendered for "patient-centered" supportive care services.

METHODS

On the basis of the Timing It Right framework, a semistructured in-depth interview was conducted with 14 patients with DTC at 5 key phases from initial diagnosis to 6 months postoperatively, and data were analyzed using the Colaizzi 7-step analysis.

RESULTS

The themes of disease experience at different phases were as follows: (1) diagnostic phase: differences in acceptance; (2) perioperative phase: physical and mental distress; (3) discharge preparation phase: anxiety and helplessness, and gap of disease knowledge; (4) discharge adjustment phase: fear of recurrence and proactive health; and (5) discharge adaptation phase: multiple needs.

CONCLUSION

The experience, care needs, and nature of the needs of patients with DTC change dynamically with the different phases of the disease. Capturing the most appropriate time throughout the continuum of care to implement supportive care that patients need most will help to improve the continuity and precision of cancer care.

IMPLICATIONS FOR PRACTICE

Healthcare providers should provide a continuum of dynamic care by scientifically and systematically assessing the actual supportive care needs of patients with DTC according to their different phases of disease.

摘要

背景

随着全球分化型甲状腺癌(DTC)发病率的持续上升,了解癌症患者在疾病不同阶段的疾病体验变得尤为重要。然而,目前缺乏针对该人群纵向疾病体验和特定需求的调查。

目的

本研究旨在探讨 DTC 患者在癌症轨迹的关键时间点的疾病体验,以便为“以患者为中心”的支持性护理服务提供支持。

方法

基于“Timing It Right”框架,对 14 例 DTC 患者在初始诊断至术后 6 个月的 5 个关键阶段进行了半结构化深入访谈,并使用 Colaizzi 7 步分析法进行数据分析。

结果

不同阶段疾病体验的主题如下:(1)诊断阶段:接受度的差异;(2)围手术期阶段:身心困扰;(3)出院准备阶段:焦虑和无助感,以及疾病知识的差距;(4)出院调整阶段:对复发的恐惧和主动健康;以及(5)出院适应阶段:多种需求。

结论

DTC 患者的体验、护理需求以及需求的性质随疾病的不同阶段而动态变化。在整个护理连续体中捕捉最适当的时间来实施患者最需要的支持性护理,将有助于提高癌症护理的连续性和精准性。

实践意义

医疗保健提供者应根据患者疾病的不同阶段,通过科学系统地评估 DTC 患者的实际支持性护理需求,提供连续动态的护理。

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