乳腺癌患者对化疗不良反应的自我报告与护理记录的一致性研究
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摘要
目的调查并分析乳腺癌术后辅助化疗患者相关不良反应的自我报告与护理记录之间的一致性。方法采用便利抽样法,选取2017年7月—2018年7月在江苏省某三级甲等肿瘤医院就诊的乳腺癌术后首次辅助化疗患者128例,采用一般资料调查表、乳腺癌患者对化疗不良反应的自我报告问卷对患者进行调查,同时从电子护理病历中提取患者不良反应的信息,与患者自我报告的结果进行比较,探讨两者一致性。结果患者自我报告的化疗不良反应的发生率及严重程度均高于护理记录的数据(P<0.05);仅呕吐这一不良反应,患者自我报告与护理记录之间的一致性一般;其余不良反应,两者之间的一致性均较差。结论护理人员存在漏记录或低估患者不良反应的情况,甚至包括一些可能导致严重并发症的症状。应考虑将患者自我报告作为常规数据收集,以便促进患者参与决策,改善就医体验。
Objective To investigate and analyze the consistency between self-reports and nursing notes in adjuvant chemotherapy-related side effects among patients with breast cancer. Methods During July 2017 to July2018,a total of 128 patients with first-time adjuvant chemotherapy after breast cancer surgery who were treated in a tertiary cancer hospital in Jiangsu Province were enrolled by convenience sampling method. Patients were investigated by general information questionnaire and self-reported questionnaire about chemotherapy-related side effects of breast cancer. At the same time,side effects information was also extracted from the electronic nursing notes to be compared with patient-reported data. Results The frequency and severity of chemotherapy-related side effects were consistently greater in patient-reported data than nurse-noted data(P<0.05). In addition to the side effect of "vomiting",the consistency between patients and nurses was general,the consistency of other items was low. Conclusion Nurses tended to underreport or underestimate side effects,including several symptoms that may cause serious complications. In the future,patient-reported outcomes should be considered for integration into clinical practice in order to facilitate patient participation in decision-making and improve the medical experience.
Objective To investigate and analyze the consistency between self-reports and nursing notes in adjuvant chemotherapy-related side effects among patients with breast cancer. Methods During July 2017 to July2018,a total of 128 patients with first-time adjuvant chemotherapy after breast cancer surgery who were treated in a tertiary cancer hospital in Jiangsu Province were enrolled by convenience sampling method. Patients were investigated by general information questionnaire and self-reported questionnaire about chemotherapy-related side effects of breast cancer. At the same time,side effects information was also extracted from the electronic nursing notes to be compared with patient-reported data. Results The frequency and severity of chemotherapy-related side effects were consistently greater in patient-reported data than nurse-noted data(P<0.05). In addition to the side effect of "vomiting",the consistency between patients and nurses was general,the consistency of other items was low. Conclusion Nurses tended to underreport or underestimate side effects,including several symptoms that may cause serious complications. In the future,patient-reported outcomes should be considered for integration into clinical practice in order to facilitate patient participation in decision-making and improve the medical experience.
引文
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[12]Gordon BE,Chen RC.Patient-reported outcomes in cancer survivorship[J].Acta Oncol,2017,56(2):166-173.
[13]皋文君,袁长蓉.患者自我报告结局测量信息系统在国外的应用进展[J].中华护理杂志,2018,53(11):1401-1405.
[14]Basch E,Iasonos A,McDonough T,et al.Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for adverse events:results of a questionnaire-based study[J].Lancet Oncol,2006,7(11):903-909.
[15]Di MM,Gallo C,Leighl NB,et al.Symptomatic toxicities experienced during anticancer treatment:agreement between patient and physician reporting in three randomized trials[J].JClin Oncol,2015,33(8):910-915.
[16]Gravis G,Marino P,Joly F,et al.Patients-self-assessment versus investigators-evaluation in a phase III trial in non-castrate metastatic prostate cancer(GETUGAFU 15)[J].Eur J Cancer,2014,50(5):953-962.
[2]范奎,代良敏,伍振峰,等.放化疗所致骨髓抑制的研究进展[J].中华中医药杂志,2017,32(1):210-214.
[3]Department of Health and Human Services FDA Center for Drug Evaluation and Research.Guidance for industry:patientreported outcome measures:use in medical product development to support labeling claims:draft guidance[J].Health Qual Life Outcomes,2006,4(79):1-20.
[4]Cirillo M,Venturini M,Ciccarelli L,et al.Clinician versus nurse symptom reporting using the National Cancer Institute-Common terminology criteria for adverse events during chemotherapy:results of a comparison based on patients self-reported questionnaire[J].Ann Oncol,2009,20(12):1929-1935.
[5]Quinten C,Maringwa J,Gotay CC,et al.Patient self-reports of symptoms and clinician ratings as predictors of overall cancer survival[J].J Natl Cancer Inst,2011,103(24):1851-1858.
[6]National Cancer Institute.Common terminology criteria for adverse events(CTCAE)v.4.03[EB/OL].(2010-06-14)[2018-11-07].https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf.
[7]郭秀花.实用医学调查分析技术[M].2版.北京:人民军医出版社,2014:219.
[8]Basch E,Deal AM,Kris MG,et al.Symptom monitoring with patient-reported outcomes during routine cancer treatment:a randomized controlled trial[J].J Clin Oncol,2016,34(6):557-565.
[9]Stover AM,Basch EM.Using patient reported outcome measures as quality indicators in routine cancer care[J].Cancer,2016,122(3):355-357.
[10]Maslowski J.Patient participation:an emerging nursing issue[J].International Journal for Human Caring,2010,17(28):74-79.
[11]Henselmans I,Haes HCJMD,Smets EMA.Enhancing patient participation in oncology consultations:a best evidence synthesis of patient-targeted interventions[J].Psycho-Oncolo,2013,22(5):961-977.
[12]Gordon BE,Chen RC.Patient-reported outcomes in cancer survivorship[J].Acta Oncol,2017,56(2):166-173.
[13]皋文君,袁长蓉.患者自我报告结局测量信息系统在国外的应用进展[J].中华护理杂志,2018,53(11):1401-1405.
[14]Basch E,Iasonos A,McDonough T,et al.Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for adverse events:results of a questionnaire-based study[J].Lancet Oncol,2006,7(11):903-909.
[15]Di MM,Gallo C,Leighl NB,et al.Symptomatic toxicities experienced during anticancer treatment:agreement between patient and physician reporting in three randomized trials[J].JClin Oncol,2015,33(8):910-915.
[16]Gravis G,Marino P,Joly F,et al.Patients-self-assessment versus investigators-evaluation in a phase III trial in non-castrate metastatic prostate cancer(GETUGAFU 15)[J].Eur J Cancer,2014,50(5):953-962.