线上课程联合回授法在喉切除患者及照顾者中的应用效果

doi:10.3969/j.issn.1674-8115.2024.10.002

摘要/Abstract

摘要：

目的·探讨线上课程联合回授法在喉切除患者及照顾者中的应用效果。方法·采用便利抽样法，选取2022年7月—2023年6月在上海市长海医院耳鼻咽喉科收治的喉切除患者及其家庭照顾者，运用随机数字表分为对照组和观察组，分别安置在2个病区进行干预。收集2组患者及照顾者的一般资料。对照组于入院后线下观看科室录制的喉癌相关知识讲解以及气道造口护理、吸痰和鼻饲等操作标准流程视频；视频分4次观看，每周1次，30 min/次。观察组入院后在线上自行观看相同的视频（8个课程），同时护理人员应用回授法进行每周1次的健康教育，每次巩固2个课程，45 min/次，共4次。分别于基线（第1周）、出院前（第4周）、出院后1个月（第8周）采用照顾者准备度量表（Caregiver Preparedness Scale，CPS）、家庭照顾者照顾能力量表（Family Caregiver Task Inventory，FCTI）、中国头颈癌患者生命质量测定量表（Quality of Life Instruments for Cancer Patients-Head and Neck Cancer，QLICP-HN），以及出院后居家护理期间不良事件发生率进行效果评价。结果·共纳入120对患者及其照顾者，对照组和观察组各60对，因各种原因2组各剔除5对，最终每组入选55对。2组患者和照顾者的一般资料、基线时患者的QLICP-HN得分，以及照顾者的CPS和FCTI得分，差异均无统计学意义（均P>0.05）。出院前和出院后1个月，观察组照顾者的CPS得分和患者的QLICP-HN得分均显著高于对照组，FCTI得分显著低于对照组（该量表得分越低表示照顾能力越强），差异均具有统计学意义（均P<0.05）。观察组在出院后1个月内居家护理不良事件发生率低于对照组（5.5% vs 29.1%），差异具有统计学意义（P<0.05）。结论·线上课程联合回授法有助于提高喉切除术后患者的家庭照顾者的照顾准备度及照顾能力，提高患者的生活质量，降低居家护理期间不良事件发生率。

关键词: 线上课程, 回授法, 喉切除术, 喉癌

Abstract:

Objective ·To explore the effect of online courses combined with the teach-back method among patients with laryngectomy and their family caregivers. Methods ·Convenience sampling was used to select patients with laryngectomy treated in the Department of Otolaryngology, Shanghai Changhai Hospital from July 2022 to June 2023 and their family caregivers. The participants were divided into a control group and an observation group using the random number table method. The intervention was conducted in two different wards. General information of the two groups of patients and caregivers was collected. After admission, the control group watched offline videos recorded by the department. The videos introduced laryngocarcinoma-related knowledge and standard procedures of airway stoma care, suctioning, nasal feeding, etc., which were divided into 4 sessions with 30 min each. The patients watched one session per week. The observation group watched the same videos (8 lessons) online on their own after admission, while the nursing staff used the teach-back method for health education, consolidating 2 lessons once a week, 45 min/session for 4 weeks. The effectiveness of the intervention was evaluated by using Caregiver Preparedness Scale (CPS), Family Caregiver Task Inventory (FCTI), and Chinese Quality of Life Instruments for Cancer Patients-Head and Neck Cancer (QLICP-HN) at baseline (1st week), before discharge (4th week), and one month after discharge (8th week), as well as the incidence of adverse events during home care. Results ·The study included a total of 120 pairs of patients and caregivers, with 60 pairs in each group. Five pairs in each group were excluded due to various reasons, leaving a total of 55 pairs in each group. There were no statistically significant differences between the two groups in terms of general information of the patients and the caregivers, QLICP-HN scores of the patients, and CPS and FCTI scores of the caregivers at baseline (P>0.05). Before discharge and 1 month after discharge, the CPS scores of the caregivers and the QLICP-HN scores of the patients in the observation group were significantly higher than those in the control group, and the FCTI scores were significantly lower (lower scores indicating better nursing care), with statistically significant differences (P<0.05). Within 1 month after discharge, the incidence of adverse home care events in the observation group was lower than that in the control group (5.5% vs 29.1%), and the difference was statistically significant (P<0.05). Conclusion ·The online courses combined with the teach-back method help improve the readiness to care and caregiving competence of family caregivers of post-laryngectomy patients, improve patients' quality of life, and reduce the incidence of adverse events during home care.

Key words: online course, teach-back method, laryngectomy, laryngocarcinoma

中图分类号:

R739.65

黄佳露, 李珊, 张才云, 徐菲. 线上课程联合回授法在喉切除患者及照顾者中的应用效果[J]. 上海交通大学学报（医学版）, 2024, 44(10): 1221-1228.

HUANG Jialu, LI Shan, ZHANG Caiyun, XU Fei. Application of online courses combined with teach-back method to laryngectomy patients and family carers[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(10): 1221-1228.

图/表 5

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Subject	Item	Observation group (n=55 pairs)	Control group (n=55 pairs)	Z/t/χ² value	P value
Patient
	Gender/n(%)			0.293	0.589
	Male	48 (87.3)	46 (83.6)
	Female	7 (12.7)	9 (16.4)
	Age/year	58.09±3.19	57.55±3.99	-0.927	0.356
	Educational attainment/n(%)			-0.653	0.514
	Primary school	6 (10.9)	6 (10.9)
	Secondary school	27 (49.1)	31 (56.4)
	College and above	22 (40.0)	18 (32.7)
Caregiver
	Gender/n(%)			0.047	0.829
	Male	15 (27.3)	14 (25.5)
	Female	40 (72.7)	41 (74.5)
	Age/year	51.85±6.36	53.33±7.35	-0.660	0.445
	Relationship with the patient/n(%)			0.379	0.827
	Mate	28 (50.9)	26 (47.3)
	Child	16 (29.1)	19 (34.5)
	Else	11 (20.0)	10 (18.2)
	Educational attainment/n(%)			-1.553	0.120
	Primary school	2 (3.6)	1 (1.8)
	Secondary school	20 (36.4)	30 (54.5)
	College and above	33 (60.0)	24 (43.7)
	Career/n(%)			1.172	0.760
	Staff	14 (25.5)	16 (29.1)
	Farmer	12 (21.8)	15 (27.3)
	Retirement	20 (36.4)	18 (32.7)
	Else	9 (16.3)	6 (10.9)
	Family monthly income/n(%)			-0.713	0.476
	<2 000 yuan	17 (30.9)	13 (23.6)
	2 000‒5 000 yuan	20 (36.4)	22 (40.0)
	>5 000 yuan	18 (32.7)	20 (36.4)

Subject	Item	Observation group (n=55 pairs)	Control group (n=55 pairs)	Z/t/χ² value	P value
Patient
	Gender/n(%)			0.293	0.589
	Male	48 (87.3)	46 (83.6)
	Female	7 (12.7)	9 (16.4)
	Age/year	58.09±3.19	57.55±3.99	-0.927	0.356
	Educational attainment/n(%)			-0.653	0.514
	Primary school	6 (10.9)	6 (10.9)
	Secondary school	27 (49.1)	31 (56.4)
	College and above	22 (40.0)	18 (32.7)
Caregiver
	Gender/n(%)			0.047	0.829
	Male	15 (27.3)	14 (25.5)
	Female	40 (72.7)	41 (74.5)
	Age/year	51.85±6.36	53.33±7.35	-0.660	0.445
	Relationship with the patient/n(%)			0.379	0.827
	Mate	28 (50.9)	26 (47.3)
	Child	16 (29.1)	19 (34.5)
	Else	11 (20.0)	10 (18.2)
	Educational attainment/n(%)			-1.553	0.120
	Primary school	2 (3.6)	1 (1.8)
	Secondary school	20 (36.4)	30 (54.5)
	College and above	33 (60.0)	24 (43.7)
	Career/n(%)			1.172	0.760
	Staff	14 (25.5)	16 (29.1)
	Farmer	12 (21.8)	15 (27.3)
	Retirement	20 (36.4)	18 (32.7)
	Else	9 (16.3)	6 (10.9)
	Family monthly income/n(%)			-0.713	0.476
	<2 000 yuan	17 (30.9)	13 (23.6)
	2 000‒5 000 yuan	20 (36.4)	22 (40.0)
	>5 000 yuan	18 (32.7)	20 (36.4)

Group	CPS score			Time effect	Cluster effect	Time×cluster effect
Group	Base line	4th week	8th week	F value (P value)	F value (P value)	F value (P value)
Observation group (n=55)	18.64±1.75	22.92±1.93	24.60±2.16	82.465 (<0.001)	51.620 (<0.001)	40.149 (<0.001)
Control group (n=55)	18.56±1.89	19.52±1.53	19.68±1.31	‒	‒	‒
t value	-0.155	6.891	9.729	‒	‒	‒
P value	0.878	<0.001	<0.001	‒	‒	‒

Group	CPS score			Time effect	Cluster effect	Time×cluster effect
Group	Base line	4th week	8th week	F value (P value)	F value (P value)	F value (P value)
Observation group (n=55)	18.64±1.75	22.92±1.93	24.60±2.16	82.465 (<0.001)	51.620 (<0.001)	40.149 (<0.001)
Control group (n=55)	18.56±1.89	19.52±1.53	19.68±1.31	‒	‒	‒
t value	-0.155	6.891	9.729	‒	‒	‒
P value	0.878	<0.001	<0.001	‒	‒	‒

Group	FCTI score			Time effect	Cluster effect	Time×cluster effect
Group	Base line	4th week	8th week	F value (P value)	F value (P value)	F value (P value)
Observation group (n=55)	21.02±2.44	16.04±2.75	15.88±2.57	94.902 (<0.001)	27.971 (<0.001)	34.872 (<0.001)
Control group (n=55)	21.02±2.14	19.56±1.88	19.48±2.35	‒	‒	‒
t value	0.000	-7.482	-7.313	‒	‒	‒
P value	1.000	<0.001	<0.001	‒	‒	‒