针对性心理护理对肿瘤内科患者治疗依从性的临床效果观察

目的探讨肿瘤内科患者接受针对性心理护理后对治疗依从性的临床效果。方法选取我院内科肿瘤患者86例为研究对象,随机分为对照组和观察组,每组43例,分别施行常规护理和针对性心理护理。对比分析两组治疗依从度。结果观察组患者接受针对性心理护理后焦虑自评量表(SAS)评分显著改善,组间差异有统计学意义(P<0.05);观察组患者在后期治疗过程中治疗依从性也大幅提高,明显高于对照组,组间差异有统计学意义(P<0.05)。结论针对性心理护理不仅有利于提高肿瘤患者治疗依从性,同时也间接改善了治疗效果,患者心理状况及生活质量得到有效改善,值得在临床上推广应用。     

基于案例学习教学法在肿瘤内科临床实习带教中的应用

基于案例学习(CBL)教学法是通过案例探讨分析来巩固知识技能的医学课程学习模式。肿瘤内科病种繁多,病情复杂,同时专业性强,内容空洞,目前肿瘤科临床实习教学过程中普遍存在教学内容滞后、学生自主性欠缺、能动性不高等问题。本文针对以上问题,根据学生自身特点,结合肿瘤内科实习阶段的教学内容,尝试将CBL教学法应用于肿瘤内科的临床实习带教中,来提高学生学习的积极主动性,启发学生的临床思维能力,培养学生独立分析及解决问题的能力,提高实习带教的教学质量。     

浅谈肿瘤内科护理纠纷的原因及防范措施

根据肿瘤内科病人的特点分析护理纠纷常见的原因。加强业务培训,提高护士综合素质;健全各项规章制度,加强职业道德教育;加强护患沟通,建立良好护患关系;进行法制教育,引导护士依法施护;规范护理文书书写等能减少护理纠纷的发生。     

共情护理对子宫肌瘤手术后患者睡眠质量与主观幸福感的影响

目的探讨共情护理对子宫肌瘤手术后患者睡眠质量与主观幸福感的影响。方法选择2013年2月至2015年2月间首都医科大学附属北京妇产医院接受手术治疗的子宫肌瘤患者160例。采用随机数字表法将患者随机分为试验组和对照组,每组各80例。试验组患者在常规护理的基础上应用共情护理,对照组患者给予常规护理。比较两组患者的主观幸福感、睡眠质量和希望水平评分。结果试验组患者正性情感(PA)、正性体验(PE)评分均高于对照组,负性情感(NA)、负性体验(NE)评分均低于对照组,差异均有统计学意义(均P<0.05)。试验组患者的匹兹堡睡眠质量指数总分及7个方面评分均低于对照组,差异均有统计学意义(均P<0.05)。试验组患者对现实和未来的积极态度、采取积极行动、与他人保持亲密的关系评分均高于对照组,差异均有统计学意义(均P<0.05)。结论在子宫肌瘤手术患者中应用共情护理可以提高患者的主观幸福感、睡眠质量和希望水平,值得临床推广应用。     

共情护理对乳腺癌患者根治手术后希望水平和主观幸福感的影响

目的探讨共情护理对乳腺癌患者根治手术后希望水平和主观幸福感的影响。方法选取2013年8月至2015年8月间秦皇岛市抚宁区人民医院收治的50例乳腺癌根治手术患者,按入组时间顺序,分为观察组和对照组,每组25例。观察组患者在术后常规护理基础上联合共情护理,对照组患者术后采用常规护理。于护理前后分别采用中文版Herth希望量表(herth hope index,HHI)、纽芬兰纪念大学幸福度量表(memorial university of newfoundland scale of happiness,MUNSH)评估和比较两组患者的希望水平及主观幸福感。结果护理后,观察组患者HHI总评分和MUNSH总评分分别为(42.3±3.1)分和(16.8±3.4)分,对照组分别为(33.5±5.2)分和(9.3±2.2)分。观察组患者HHI总评分和MUNSH总评分均显著高于对照组,差异有统计学意义(P<0.05)。结论对乳腺癌患者根治术后实施共情护理,可显著提高其希望水平和主观幸福感。     

共情式干预对骨转移癌放疗患者疼痛程度、生活质量及心理状态的影响

目的 研究共情式干预对骨转移癌放疗患者疼痛程度、生活质量、心理状态的影响.方法 将72例骨转移癌放疗患者按照随机数字表法分为对照组和观察组,每组36例.对照组采用常规干预,观察组在对照组基础上应用共情式干预.比较两组患者干预前后的疼痛程度、生活质量、心理状态的变化情况,统计两组患者的不良反应发生率.结果 干预前,两组患...     

案例教学法在肿瘤内科NCCN指南教学中的应用

目的：比较传统教学法（lecture-based learning,LBL）和案例教学法（case-based learning,CBL）在肿瘤内科美国综合肿瘤网络中心（national comprehensive cancer network,NCCN）临床实践指南（简称NCCN指南）教学中的应用效果。方法分别采用LBL和CBL对56名肿瘤学研究生进行NCCN指南教学,通过试卷考核及调查问卷,比较两种教学方法的教学效果。结果 CBL组学生的基础理论成绩和临床应用成绩均优于LBL组（P=0.02,P=0.03）,学生对CBL评价更高（P〈0.05）。结论 CBL在肿瘤内科NCCN指南教学中的效果优于LBL。     

临床护理路径在肝癌介入术后护理中的应用效果观察

目的探讨临床护理路径在肝癌介入术后护理中的应用效果。方法选取2019年6月至2021年6月间宝鸡市中心医院收治的90例行肝癌介入术的患者,采用随机数表法分为观察组和对照组,每组45例。对照组患者术后采用常规护理措施干预,观察组患者术后采用临床护理路径干预,比较两组患者的护理满意度、疼痛评分、遵医行为和并发症发生情况。结果护理前,两组患者疼痛评分比较,差异无统计学意义(P>0.05)。护理后,两组疼痛评分均降低,观察组低于对照组,差异均有统计学意义(均P<0.05)。观察组护理满意度为95.6%,高于对照组的82.2%,且观察组遵医行为均高于对照组,差异均有统计学意义(均P<0.05)。观察组并发症发生率为2.2%,低于对照组的13.3%,差异有统计学意义(P<0.05)。结论肝癌介入术患者行临床护理路径护理干预,可提升患者的护理满意度和遵医行为,减少术后并发症发生率,缓解疼痛,值得临床研究与借鉴。     

“始于同情,达于共情”——致肿瘤患者“亲友团”

“共情”这个词是舶来品,平时不太使用,近十年在学术交流和媒体中才开始用得多起来。共情理论自20世纪50年代创立以来,对推动临床医护人员乃至患者的亲友陪员更好地陪伴并服务于患者很有实际意义,值得大家了解。     

妇科恶性肿瘤患者的心理护理效果

目的探讨心理护理在妇科恶性肿瘤护理中的应用效果。方法选取2011年1月至2012年12月间100例妇科肿瘤患者为研究对象,按照随机数字法分为对照组和干预组,对照组给予肿瘤内科的常规护理,而干预组在常规护理基础上实施心理护理干预,观察两组的治疗效果。结果干预组的护理满意度为96.0%,对照组的护理满意度为80.0%,差异有统计学意义(P<0.05)。干预组和对照组护理前的SAS、SDS评分比较,差异无统计学意义(P>0.05);干预组和对照组护理后的SAS和SDS评分较护理前均有明显的改善,差异有统计学意义(P<0.05)。结论对于妇科恶性肿瘤患者实施心理护理干预措施是可行的,能够有效提高患者的临床护理满意度,并且改善患者焦虑和抑郁状况,值得在临床中应用与推广。     

Clarifying the term 'palliative' in clinical oncology

The objective of this study was to clarify the term 'palliative' in clinical oncology. A qualitative study design with in-depth interviews was applied. The study sample included 30 cancer patients and 16 physicians. In clinical oncology, the use of the term 'palliative' to describe both anticancer treatments and palliative care may cause confusion and misunderstanding. Different aspects of palliative care, as expressed by the WHO definition, are not so easily recognizable with regard to palliative oncological treatments. Furthermore, the fact that the same anticancer treatments can be given to patients with palliative or curative intention is confusing. The distinction between curative and palliative oncological treatments is of crucial importance for the treatment decision-making process. Close consideration of the use of the term 'palliative' will help to clarify the various goals of treatment and care in oncological practice.     

Attrition rates,reasons, and predictive factors in supportive care and palliative oncology clinical trials

BACKGROUND:

Attrition is common among supportive care/palliative oncology clinical trials. However, to the authors' knowledge, few studies to date have documented the reasons and predictors for dropout. In the current study, the authors' objective was to determine the rate, reasons, and factors associated with attrition both before reaching the primary endpoint and at the end of the study.

METHODS:

A review of all prospective interventional supportive care/palliative oncology trials conducted in the Department of Palliative Care and Rehabilitation Medicine at The University of Texas MD Anderson Cancer Center in Houston between 1999 and 2011 was performed. Patient and study characteristics and attrition data were extracted.

RESULTS:

A total of 1214 patients were included in 18 clinical trials. The median age of the patients was 60 years. Approximately 41% had an Eastern Cooperative Oncology Group performance status of ≥ 3, a median Edmonton Symptom Assessment Scale (ESAS) for fatigue of 7 of 10, and a median ESAS for dyspnea of 2 of 10. The attrition rate was 26% (95% confidence interval [95% CI], 23%‐28%) for the primary endpoint and 44% (95% CI, 41%‐47%) for the end of the study. Common reasons for primary endpoint dropout were symptom burden (21%), patient preference (15%), hospitalization (10%), and death (6%). Primary endpoint attrition was associated with a higher baseline intensity of fatigue (odds ratio [OR], 1.10 per point; P = .01) and a longer study duration (P = .04). End‐of‐study attrition was associated with higher baseline levels of dyspnea (OR, 1.06; P = .01), fatigue (OR, 1.08; P = .01), Hispanic race (OR, 1.87; P = .002), higher level of education (P = .02), longer study duration (P = .01), and outpatient studies (P = 0.05).

CONCLUSIONS:

The attrition rate was high in supportive care/palliative oncology clinical trials, and was associated with various patient characteristics and a high baseline symptom burden. These findings have implications for future clinical trial design including eligibility criteria and sample size calculation. Cancer 2013. © 2012 American Cancer Society.     

树突状细胞技术在肿瘤临床治疗中的应用

树突状细胞主动免疫治疗是近年来国内外肿瘤治疗研究的特点。本文从树突状细胞的来源、抗原的装载、免疫途径、临床应用以及病人的选择等多个方面进行综述,为进一步研究提供基础。     

Imaging as a diagnostic and therapeutic tool in clinical oncology

According to the WHO report published in 2010, about 13% of all deaths are due to cancer. Of these, lung, liver, stomach, colon and breast cancer are the most prevalent. It was also reported that about 30% of the deaths due to cancer can be avoided, if diagnosed and treated early. Hence, there is an urgent need to diagnose these cancers efficiently. Various imaging and therapeutic methods have been proposed and used to accurately detect cancer. In this special two issues, there are eight papers covering different aspects of oncology using various imaging or therapeutic methods.     

临床路径在原发性颅内肿瘤手术患者围术期护理的应用分析

目的探讨原发性颅内肿瘤手术患者围手术期采用临床路径模式进行护理的效果。方法选取原发性颅内肿瘤手术患者140例,随机分为对照组（67例）和观察组（73例）。对照组患者实施常规护理,观察组患者采取临床路径进行护理。对两组患者治疗情况和护理满意度进行统计、评价和比较。结果观察组患者住院时间、住院费用分别为（23.85±10.05）d和（17382.74±694.28）元,对照组患者分别为（36.16±10.48）d和（26393.86±669.27）元,观察组患者住院时间和住院费用均明显少于对照组,差异有统计学意义（P〈0.05）。观察组61（83.6%）例患者恢复良好,明显高于对照组的47例（70.1%）;分别有65.8%和94.5%的观察组患者对护理感到非常满意和满意,明显多于对照组的53.7%和86.6%,两组患者比较,差异均有统计学意义（均P〈0.05）。结论对原发性颅内肿瘤手术患者围手术期采用临床路径模式进行护理可以有效提高护理质量,改善护患关系。     

Exploring consent to randomized placebo-controlled clinical trials in oncology

Aims: Randomized placebo‐controlled trials are critical for advancing knowledge in oncology, yet little is known about optimal communication for informed consent. This study aimed to identify patient preferences for and satisfaction with three consultation styles (information‐focused, emotion‐focused and collaborative) in simulated discussions of four clinical trial concepts (randomization, placebo, tissue analysis and oncologists’ recommendation). Methods: In total 75 Australian cancer patients and carers, or both, viewed videotaped simulated consultations with a doctor and patient discussing a randomized, placebo‐controlled trial. Their satisfaction and preferences for both consultation style and information were assessed. The patients’ characteristics and decision‐making preferences were also evaluated as potential predictors for consultation style preference. Results: Participants preferred a collaborative consultation style when discussing randomization (74.6%), placebo (71.4%) and oncologist's recommendation (77%). However an emotion‐focused consultation style was preferred when discussing tissue analysis (81%). The participants represented a highly information‐seeking group, although most favoured collaborative or passive roles in treatment decision‐making. Limited variables were identified that predict consultation style preference. Conclusion: While supporting the value of a collaborative approach to clinical trial communications, the study finding that tissue analysis requires a more emotion‐focused approach highlights a new focus for trial communication and confirms the need for doctors to remain flexible in their consultation style.     

Evaluating the quality of psychosocial care in outpatient medical oncology settings using performance indicators

Objective: An American Psychosocial Oncology Society workgroup has developed indicators of the quality of psychosocial care that can be measured through review of medical records. The present report describes the first large‐scale use of these indicators to evaluate psychosocial care in outpatient medical oncology settings. Methods: Medical records of 1660 colorectal, breast and non‐small cell cancer patients first seen by a medical oncologist in 2006 at 11 practice sites in Florida were reviewed for performance on indicators of the quality of psychosocial care. Results: Assessment of emotional well‐being was significantly less likely to be documented than assessment of pain (52 vs 87%, p<0.001). A problem with emotional well‐being was documented in 13% of records and evidence of action taken was documented in 58% of these records. Ten of eleven practice sites performed below an 85% threshold on each indicator of psychosocial care. Variability in assessment of emotional‐well being was associated (p<0.02) with practice site and patient gender and age while variability in assessment of pain was associated (p<0.001) with practice site and cancer type. Conclusions: Findings illustrate how use of the psychosocial care indicators permits identification of specific practice sites and processes of care that should be targeted for quality improvement efforts. Additionally, findings demonstrate the extent to which routine assessment of emotional well‐being lags behind routine assessment of pain in cancer patients. Copyright © 2010 John Wiley & Sons, Ltd.     

The next generation of the supportive care needs survey: a brief screening tool for administration in the clinical oncology setting

Objective: The short form of the Supportive Care Needs Survey (SCNS‐SF34) is a 34‐item instrument for assessing the perceived needs of people diagnosed with cancer. This research is aimed at developing a brief screening tool for administration to patients in the clinical setting, by identifying the minimum number and optimal combination of item(s) to measure each of the SCNS‐SF34 domains with high sensitivity and specificity. Methods: Secondary analyses were undertaken on data from 1458 patients at 12 major public cancer treatment centres in Australia; with a random sample of 67% (n = 977) of the patient records selected as the developmental sample for developing the screening tool, while the remaining 33% (n = 481) constituted the validation sample on which analyses were repeated. Five criteria were applied to identify the optimum subset of items for the screening tool. Where statistical results were very similar across candidate item/s, items deemed more clinically important were chosen. Results: Nine items were identified, which can be efficiently and reliably used as a brief screening tool (SCNS‐ST9). An overall comparison of the results on the SCNS‐ST9 with the original SCNS‐SF34 indicates that only 11% of people reporting at least one moderate/high need on any SCNS‐SF34 domain were missed as having a moderate/high need on the SCNS‐ST9. Conclusions: Our very brief screening tool can be implemented in a clinical setting to reliably screen for unmet needs among cancer patients, with considerable savings in time and expense, increasing its potential for wide‐scale adoption in clinical settings. Copyright © 2011 John Wiley & Sons, Ltd.     

Barriers to the provision of evidence-based psychosocial care in oncology

Meeting the psychological, social and physical needs of people with cancer is a challenge for individual health practitioners, health administrators and health policy makers. However, there is a considerable gap between recommended best-evidence psychosocial and supportive care and actual practice. This paper provides a discussion of the reasons for this gap using the precede-proceed model as a theoretical framework. The model is a useful way of classifying potential barriers to the application of recommended best practice into three categories: predisposing factors which influence motivation to behave in a particular way, enabling factors which facilitate the enactment of the behaviour and reinforcing factors which increase the likelihood that the behaviour will be maintained over time. Ways of addressing these barriers are proposed and discussed.