以质量求发展，以服务铸品牌

护理学报 ›› 2024, Vol. 31 ›› Issue (15): 34-38.doi: 10.16460/j.issn1008-9969.2024.15.034

• 循证护理 • 上一篇    下一篇

基于循证和中医理念的乳腺癌化疗患者癌因性疲乏护理干预方案的构建

戴美芬1, 梁钰贞2, 杨静1, 尤燕燕1, 杨清1, 昌广婷2, 区幸莹1, 黄传蔷1, 陈智星1, 区洁芬1   

  1. 1.华南理工大学附属第六医院,广东 佛山 528000;
    2.广东药科大学 护理学院,广东 广州 510000
  • 收稿日期:2024-04-10 出版日期:2024-08-10 发布日期:2024-09-04
  • 通讯作者: 区洁芬（1973-）,女,广东南海人,本科学历,主任护师,护理部主任。E-mail: 63015911@qq.com
  • 作者简介:戴美芬（1981-）,女,江西上饶人,本科学历,主任护师,护理教研室主任。
  • 基金资助:
    佛山市科学技术局佛山市自筹经费类科技创新项目（编号：2220001004015）

Construction of nursing protocol for cancer-related fatigue in breast cancer patients undergoing chemotherapy based on evidence-based practice and theory of chinese medicine

DAI Mei-fen1, LIANG Yu-zhen2, YANG Jing1, YOU Yan-yan1, YANG Qing1, CHANG Guang-ting2, OU Xing-ying1, HUANG Chuan-qiang1, CHEN Zhi-xing1, OU Jie-fen1   

  1. 1. The Sixth Affiliated Hospital of South China University of Science and Technology, Foshan 528000, China;
    2. School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510000, China
  • Received:2024-04-10 Online:2024-08-10 Published:2024-09-04

PDF (PC)

171

赞

摘要： 目的 基于循证医学与中医理论的结合,构建针对乳腺癌化疗患者癌因性疲乏的护理干预方案,以改善患者癌因性疲乏、生活质量和健康状况。方法 基于循证护理的方法,检索、评价、汇总国内外关于中医理念下乳腺癌化疗患者癌因性疲乏护理的最佳证据,构建中医理念的乳腺癌化疗患者癌因性疲乏护理干预方案基本框架。采用德尔菲专家咨询法对18名专家开展2轮函询,通过专家小组会议的形式进行第3轮意见征询,最终确定方案各级条目。方案包括乳腺癌疲乏筛查、健康教育、个性化疲乏管理等措施。结果 本研究共18名专家全程参与2轮函询和1次专家小组会议,2轮函询问卷回收率均为100%,专家权威系数分别为0.86、0.86;Kendall’s W值分别为0.08（χ2=19.89,P=0.13）、0.15（χ2=90.99,P<0.001）,经专家小组会议讨论,最终达成一致意见。结论 基于循证医学与中医理念构建的乳腺癌化疗患者癌因性疲乏护理干预方案,能为临床护理工作提供参考和指导,有助于提高患者生活质量。

关键词: 乳腺癌, 化疗, 癌因性疲乏, 中医护理, 循证护理

Abstract: Objective To develop a nursing protocol for cancer-related fatigue in breast cancer patients undergoing chemotherapy based on the combination of evidence-based medicine and traditional Chinese medicine (TCM) theory, and to improve patients' cancer-related fatigue, quality of life, and health. Methods Following the evidence-based nursing approach, the best evidence on TCM nursing for cancer-related fatigue in breast cancer patients undergoing chemotherapy was retrieved, evaluated, and summarized. Basic framework of nursing protocol for cancer-related fatigue in breast cancer patients undergoing chemotherapy was constructed based on TCM theory. Delphi method was used to conduct two rounds of survey among 18 experts, and an expert panel meeting was held to identify the items at each level of the protocol. The protocol included measures such as fatigue screening, health education, and personalized fatigue management. Results A total of 18 experts participated in two rounds of survey and one expert panel meeting. The response rate for both rounds of survey was 100%, and the expert authority coefficient was 0.86 and 0.86, respectively. Kendall's W value was 0.08（χ2=19.89, P=0.13） and 0.15 （χ2=90.99, P<0.001）, respectively. The final nursing protocol was developed through discussions in the expert panel meeting. Conclusion The nursing protocol for cancer-related fatigue in breast cancer patients undergoing chemotherapy constructed based on evidence-based medicine and TCM theory can provide reference and guidance for clinical nursing and help improve patients' quality of life.

Key words: breast cancer, chemotherapy, cancer-related fatigue, TCM nursing, evidence-based nursing

中图分类号: 

  • R473.73
[1] Britt KL, Cuzick J, Phillips KA.Key steps for effective breast cancer prevention[J].Nat Rev Cancer, 2020,20(8):417-436. DOI: 10.1038/s41568-020-0266-x.
[2] Vij S, Dhasmana DC, Bala S, et al.Efficacy of antiemetic regimens for prevention and treatment of chemotherapy-induced nausea and vomiting in patients of breast cancer receiving highly emetogenic chemotherapy[J]. Indian J Med Paediatr Oncol, 2021, 42(5):446-451. DOI:10.4103/ijmpo.ijmpo_200_20.
[3] Kang D, Kim S, Kim H, et al.Surveillance of symptom burden using the patient-reported outcome version of the common terminology criteria for adverse events in patients with various types of cancers during chemoradiation therapy: real-world study[J]. JMIR Public Health Surveill, 2023, 9(1): e44105. DOI: 10.2196/44105.
[4] Vaz-Luis I, Di Meglio A, Havas J, et al.Long-term longitudinal patterns of patient-reported fatigue after breast cancer: a group-based trajectory analysis[J]. J Clin Oncol, 2022, 40(19): 2148-2158. DOI: 10.1200/JCO.21.01958.
[5] Thong MSY, van Noorden CJF, Steindorf K, et al. Cancer-related fatigue:causes and current treatment options[J]. Curr Treat Options Oncol, 2020,21(2):17. DOI:10.1007/s11864-020-0707-5.
[6] 高瞻. 化疗相关性便秘的中医护理技术研究进展[J].护理研究,2024,38(2):323-326.DOI:10.12102/j.issn.1009-6493.2024.02.022.
[7] 贺海霞,胡向丹.中医特色疗法在妇科肿瘤的运用[M].北京:人民卫生出版社,2021.
[8] Dicenso A, Bayley L, Haynes RB. ACP Journal Club.Editorial: accessing preappraised evidence: fine-tuning the 5S model into a 6S model[J]. Ann Intern Med, 2009, 151(6): 99-101. DOI: 10.1136/ebn.12.4.99-b.
[9] Brouwers MC, Kho ME, Browman GP, et al.AGREE II: advancing guideline development, reporting and evaluation in health care[J]. CMAJ, 2010,182(18):E839-E842. DOI:10.1503/cmaj.090449.
[10] 周芬,郝玉芳,丛雪,等.指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J].护理学报, 2018, 25(18):3.DOI:10.16460/j.issn1008-9969.2018.18.056.
[11] 胡雁. 循证护理学[M].北京:人民卫生出版社,2012.
[12] 周英凤,顾莺,胡雁,等. JBI循证卫生保健中心对关于不同类型研究的质量评价工具—患病率及分析性横断面研究的质量评价[J].护士进修杂志,2018,33(3):219-221.DOI:10.16821/j.cnki.hsjx.2018.03.007.
[13] 熊俊,陈日新.系统评价/Meta分析方法学质量的评价工具AMSTAR[J].中国循证医学杂志,2011,11(9):6.DOI:10.3969/j.issn.1672-2531.2011.09.017.
[14] 刘芯言,云洁,陈倩,等.耳穴贴压治疗癌因性疲乏的有效性与安全性的Meta分析[J].中国民间疗法,2022,30(1):60-66.DOI:10.19621/j.cnki.11-3555/r.2022.0121.
[15] Alisaleh E, Ghahari S.Effectiveness of mindfulness-based stress reduction (MBSR) in stress and fatigue in patients with multiple sclerosis (MS)[J]. Int J Med Res Health Sci, 2016, 5(11):434-440. DOI:10.1016/j.msard.2022.104029.
[16] 韩金钱,张宜佳,蒋恩社.艾灸对癌症病人癌因性疲乏干预效果的Meta分析[J].循证护理,2021,7(6):8.DOI:10.12102/j.issn.2095-8668.2021.06.002.
[17] 中国抗癌协会癌症康复与姑息治疗专业委员会,中国临床肿瘤学会肿瘤支持与康复治疗专家委员会.癌症相关性疲乏诊断与治疗中国专家共识[J].中华医学杂志, 2022,102(3):10.DOI:10.3760/cma.j.cn112137-20210811-01789.
[18] 侯婷婷,田佳欢,凡丹,等.乳腺癌化疗患者癌因性疲乏的中医护理应用进展[J].内科,2023, 18(3):270-273.DOI:10.16121/j.cnki.cn45-1347/r.2023.03.14.
[19] 张黎丹,刘昌梅,高瑞,等.五行音乐疗法联合穴位贴敷在改善肺癌患者化疗后癌因性疲乏症状的运用研究[J].中医临床研究,2021,13(3):87-90.DOI:10.3969/j.issn.1674-7860.2021.03.032.
[20] 李小妹,杨柳,杜建,等.癌因性疲乏患者对中医食疗需求的质性研究[J].光明中医, 2023, 38(1):22-26.DOI: 10. 3969 /j. issn. 1003-8914. 2023. 01. 006.
[21] 邱萍,王宝宽,陈丽.八段锦联合情志护理对恶性肿瘤患者癌因性疲乏及负性情绪的影响[J].中西医结合护理(中英文),2019,5(1):4.DOI:DOI10.11997 /nitcwm. 201901023.
[22] 胡辉,吴芳,朱建华.磁珠耳穴疗法合中医情志护理对乳腺癌患者化疗后睡眠及生活质量的影响[J].湖南中医杂志, 2020, 36(11):3.DOI:10.16808/j.cnki.issn1003-7705.2020.11.047.
[23] 段艳芳,王海蓉,许慧娟,等.芳香疗法联合穴位按摩缓解乳腺癌术后化疗患者疲乏与睡眠障碍[J]. 护理学杂志,2022,37(17):50-54.DOI:10.3870/j.issn.1001-4152.2022.17.050.
[24] 周英凤,朱政,胡雁,等.推动证据向临床转化(八)审查指标的构建[J].护士进修杂志,2020,35(14):4.DOI:10.16821/j.cnki.hsjx.2020.14.007.
[25] 景城阳,刘瑞雪,褚红玲,等.医学研究领域德尔菲法实施和报告标准(CREDES)解读[J].中国循证医学杂志,2023,23(2):233-239.DOI:10.7507/1672-2531.202210047.
[26] 何久智,王瑞,张凤云.基于德尔菲法构建后颅窝肿瘤患儿家长健康教育护理路径[J].中国健康教育, 2024, 40(2):172-176.DOI:10.16168/j.cnki.issn.1002-9982.2024.02.016.
[27] Ziglio E,Adler M.Gazing into the oracle: the Delphi method and its application to social policy and public health[M]. London: Jessica Kingsley Publishers, 1996.
[28] Tsai HY, Wang CJ, Mizuno M, et al.Predictors of cancer-related fatigue in women with breast cancer undergoing 21 days of a cyclic chemotherapy[J]. Worldviews Evid Based Nurs, 2022, 19(3):211-218. DOI: 10.1111/wvn.12573.
[29] 王建东,赵春英,王凤,等.1192例乳腺癌患者癌因性疲乏的调查及影响因素分析[J]. 同济大学学报(医学版),2022,43(3):427-435.DOI:10. 12289 /j.issn.1008-0392. 22062.
[30] 袁颖.中医护理干预对减少肺癌化疗不良反应中的应用价值[J].中华肿瘤防治杂志,2018,25(S1):217;219.DOI:10.16073/j.cnki.cjcpt.2018.s1.100.
[1] 郭林芳, 张培莉, 侯晓雅, 李滢, 曹敏, 高超越. 肝癌化疗患者线上线下结合营养干预方案的构建[J]. 护理学报, 2025, 32(4): 1-5.
[2] 张静, 彭焕椽, 陈佳, 鲁永锦, 刘克玄, 侯晓敏. 成人体外循环心脏手术患者预防手术部位感染的最佳证据总结[J]. 护理学报, 2025, 32(4): 41-47.
[3] 刘璐, 朱钰, 曹义, 张华, 彭玉娜. 腹腔热灌注化疗患者术中实施不同目标体温管理的效果观察[J]. 护理学报, 2025, 32(4): 59-63.
[4] 李若雨, 刘鑫, 林萍, 陈丹, 林桦. 出院患者用药安全管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 50-55.
[5] 杨小娟, 毛孝容, 王静, 江华, 李蓉, 樊宇, 文青, 李林章, 陈晓容. 成人重度烧伤患者早期肠内营养管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 56-61.
[6] 曹敏, 张培莉, 侯晓雅, 高超越, 郭林芳, 李滢. ABC-X模型下结直肠癌化疗患者照顾者营养照护体验的质性研究[J]. 护理学报, 2025, 32(2): 13-18.
[7] 刘硕怡, 熊莉娟, 李凌, 王玉梅, 何嘉, 李鑫, 袁淑蕾, 郭雪琴, 王暘婧, 张慧娟. 老年住院患者衰弱预防及管理临床实践指南的质量评价及内容分析[J]. 护理学报, 2025, 32(2): 50-55.
[8] 闫亚铃, 乐美妮, 姚桃琴, 王雪莲, 姜建玲, 辛艺. 老年胃肠肿瘤患者围手术期衰弱管理方案的构建[J]. 护理学报, 2025, 32(2): 74-78.
[9] 刘琪, 刘佳丽, 刘玉, 杨丽敏, 范育英, 吕星, 覃惠英. 鼻咽癌患者诱导化疗序贯同期放化疗期间躯体-心理症状负担轨迹及影响因素研究[J]. 护理学报, 2025, 32(1): 1-6.
[10] 陈洁, 孟庆童, 刘惊今, 吴艳妮. 基于指南的慢性心力衰竭患者运动康复科普手册研制[J]. 护理学报, 2024, 31(9): 36-41.
[11] 符路路, 解艺璇, 王玥, 魏巍, 张传英, 朱宇. 新生儿操作性疼痛听觉刺激干预的证据总结[J]. 护理学报, 2024, 31(9): 42-47.
[12] 华晶, 张青月, 王燕, 程畅, 张秀丽, 张爱爱. 问题提示清单在乳腺癌手术患者中的应用研究[J]. 护理学报, 2024, 31(8): 18-22.
[13] 纪锐婷, 林丹娜, 刘小成, 李婷婷, 谢映梅, 胡冰, 应文娟. 早产儿初乳口腔免疫疗法的最佳证据总结[J]. 护理学报, 2024, 31(8): 37-42.
[14] 张小莉, 杨鑫玉, 肖宇, 刘春燕, 张璐, 伍晓琴, 黄月霖, 傅静. 晚期癌症患者代理决策者安宁疗护决策后悔研究的范围综述[J]. 护理学报, 2024, 31(8): 49-54.
[15] 周毅峰, 杨继平, 胡正中, 袁浩. 肝癌切除手术患者目标导向性血糖监测的证据总结[J]. 护理学报, 2024, 31(7): 46-50.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!