Li Caixia, Lu Xiling, Xu Juan, Gao Fei, Lee Eunice, Chan Carmen W H
The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China.
The Public Health Center, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan Province, China.
Int J Nurs Stud. 2023 Dec;148:104610. doi: 10.1016/j.ijnurstu.2023.104610. Epub 2023 Sep 21.
The globally endemic hepatocellular carcinoma induced by hepatitis B highlights the need for an ultrasonography-based screening strategy to reduce the tumour burden. However, patient non-adherence due to unawareness and complex decisions in weighting uncertainties of hepatocellular carcinoma screening has continuously challenged its continuum.
To examine the effectiveness and process of a nurse-led decision counselling programme for improving hepatocellular carcinoma screening among patients with hepatitis B.
Single-blind randomised controlled trial.
Between 12 March and 19 July 2021, 178 patients with hepatitis B were recruited from six inpatient wards of a university-affiliated hospital in northern China.
Participants were randomly allocated to receive usual care (n = 89) or usual care plus a nurse-led decision counselling programme (n = 89). Underpinned by the preventive health model, the programme consisted of health education, tailored information, and values clarification exercises to elicit informed and value-based preferences for hepatocellular carcinoma screening. Screening barriers were explored and addressed through procedural problem-solving. Hepatocellular carcinoma screening rate at six months post-baseline was the primary outcome. Secondary outcomes (knowledge, perceptions, and decision conflicts regarding hepatocellular carcinoma screening) were measured at baseline (T0), immediately after the intervention (T1), and the six-month follow-up (T2). A Medical Research Council framework-guided process evaluation was conducted by drawing on data from intervention documentation, WeChat discussions, and interviews with stakeholders (n = 13).
With a mean age of 47.32 (8.78) years, participants mostly occupied rural residences (63.5 %). Compared with the control group, the intervention group had significantly higher hepatocellular carcinoma screening rates (75.6 % vs. 42.1 %, p < 0.001) and displayed greater improvements in the scores of hepatocellular carcinoma screening knowledge (β = 3.643, 95 % confidence interval [CI] = 3.030, 4.255), salience and coherence (β = 0.410, 95 % CI = 0.234, 0.586), response efficacy (β = 0.327, 95 % CI = 0.181, 0.473), and perceived susceptibility (β = 0.214, 95 % CI = 0.040, 0.388) at T1. Improvement in perceived susceptibility was not maintained, whereas a higher decrease of the decision conflict score was found at T2 (β = -4.156, 95 % CI = -7.851, -0.461). The process evaluation revealed potential intervention mechanisms and contextual factors affecting intervention effectiveness, such as living status and natural disasters.
The programme was effective in improving hepatocellular carcinoma screening and showed that nurses could play a decision counselling role in optimising the screening among patients with hepatitis B.
ClinicalTrials.govNCT04659005. Registration date: 9 December, 2020.
Nurse-led decision counselling improves hepatocellular carcinoma screening in patients with hepatitis B.
乙型肝炎引发的全球地方性肝细胞癌凸显了基于超声检查的筛查策略对于减轻肿瘤负担的必要性。然而，由于患者缺乏认识以及在权衡肝细胞癌筛查不确定性时面临复杂决策，导致患者依从性差，这一直对筛查的持续性构成挑战。
探讨由护士主导的决策咨询项目在提高乙型肝炎患者肝细胞癌筛查率方面的有效性及过程。
单盲随机对照试验。
2021年3月12日至7月19日，从中国北方一所大学附属医院的六个住院病房招募了178例乙型肝炎患者。
参与者被随机分配接受常规护理（n = 89）或常规护理加护士主导的决策咨询项目（n = 89）。该项目以预防健康模型为基础，包括健康教育、个性化信息以及价值观澄清练习，以引导患者对肝细胞癌筛查形成基于信息和价值观的明智偏好。通过程序性问题解决来探索并解决筛查障碍。以基线后六个月的肝细胞癌筛查率作为主要结局指标。在基线（T0）、干预后即刻（T1）以及六个月随访（T2）时测量次要结局指标（关于肝细胞癌筛查的知识、认知及决策冲突）。通过借鉴干预记录、微信讨论以及与利益相关者的访谈（n = 13）数据，开展了一项医学研究理事会框架指导下的过程评估。
参与者的平均年龄为47.32（8.78）岁，大多数居住在农村（63.5%）。与对照组相比，干预组的肝细胞癌筛查率显著更高（75.6%对42.1%，p < 0.001），并且在T1时肝细胞癌筛查知识得分（β = 3.643，95%置信区间[CI] = 3.030，4.255）、显著性和连贯性得分（β = 0.410，95% CI = 0.234，0.586）、反应效能得分（β = 0.327，95% CI = 0.181，0.473）以及感知易感性得分（β = 0.214，95% CI = 0.040，0.388）方面有更大改善。感知易感性的改善未得到维持，而在T2时决策冲突得分有更高程度的降低（β = -4.156，95% CI = -7.851，-0.461）。过程评估揭示了影响干预效果的潜在干预机制和背景因素，如生活状况和自然灾害。
该项目在提高肝细胞癌筛查率方面有效，表明护士在优化乙型肝炎患者筛查中可发挥决策咨询作用。
ClinicalTrials.govNCT04659005。注册日期：2020年12月9日。
护士主导的决策咨询可提高乙型肝炎患者的肝细胞癌筛查率。
