【原】基于微信的多模式护理方案对乳腺癌术后妇女早期康复的益处：一项临床随机对照试验（#护理SCI）

【推荐理由】

随着移动互联网的普及和覆盖范围的扩大，移动医疗服务是研究的热点。基于微信的多模式护理计划，用于乳腺癌患者手术后的早期康复的研究很少，这篇文章的多模式护理计划（生理-心理和社会康复）、研究流程、数据处理以及讨论的分析都很值得参考。期待这种护理模式将为更多的癌症患者带来帮助。

Zhou K, Wang W, Zhao W, Li L, Zhang M, Guo P, Zhou C, Li M, An J, Li J, Li X. Benefits of a WeChat-based multimodal nursing program on early rehabilitation in postoperative women with breast cancer: A clinical randomized controlled trial. Int J Nurs Stud. 2020 Jun; 106:103565.

基于微信的多模式护理方案对乳腺癌术后妇女早期康复的益处：一项临床随机对照试验

Background 研究背景

Breast cancer is the most common malignant tumor in women worldwide; its incidence and mortality rates rank first and second, respectively. Primary treatments for early-stage breast cancer can cause adverse effects, such as pain, fatigue, and sleep disturbance, that can markedly affect the patients’ health-related quality of life. Several strategies have been used to improve the HRQoL of women with breast cancer, including mindfulness-based training, physical activity, group-based intervention, and bio-psychosocial intervention. Although these programs yielded satisfactory outcomes, few encompass a comprehensive approach that include physical, psychological, and social rehabilitation combined during the postoperative period. However, a WeChat-based multimodal nursing program for early rehabilitation in women with breast cancer who have undergone surgery has not been reported nationally and internationally to date.

乳腺癌是世界上最常见的女性恶性肿瘤，发病率和死亡率分别位居第一和第二位。早期乳腺癌的初级治疗可能会导致不良反应，如疼痛、疲劳和睡眠障碍，这些都会显著影响患者与健康相关的生活质量(HRQoL)。有几种策略已经被用来改善乳腺癌妇女的HRQoL，包括基于正念的训练、体力活动、基于群体的干预和生物心理社会干预。虽然这些方案取得了令人满意的结果，但很少有方案包含综合的方法，包括术后期间身体、心理和社会康复相结合。然而，到目前为止，国内和国际上还没有报道基于微信的多模式护理计划，用于乳腺癌患者手术后的早期康复。

Objective 研究目的

This study aimed to evaluate the benefits of a WeChat-based multimodal nursing program on early rehabilitation in postoperative women with breast cancer

本研究旨在评估以微信为基础的多模式护理方案对乳腺癌术后妇女早期康复的益处。

Design 研究设计

Clinical randomized controlled trial.

本研究为临床随机对照试验。

Participants and Setting 研究对象

Participants: Women with breast cancer were recruited via convenience sampling. The inclusion criteria were (1) age ≥18 years, (2) newly diagnosed with breast cancer, (3) stage I–III disease, and (4) indicated for surgery with adjuvant therapy. Exclusion criteria were (1) comorbidity with other malignant tumors and infections and (2) cognitive or psychiatric disorders.

以方便抽样的方式招募乳腺癌女性患者。纳入标准为(1)年龄≥18岁，(2)新诊断为乳腺癌，(3)I-III期疾病，(4)接受手术辅助治疗。排除标准为(1)合并其他恶性肿瘤和感染，(2)认知或精神障碍。

Method 研究方法

We recruited patients with breast cancer and randomly allocated them to the intervention (n = 56) and control (n = 55) groups. The former was subjected to the WeChat-based multimodal nursing program plus routine nursing care for 6 months, whereas the latter received only routine nursing care. The primary endpoint (health-related quality of life) and secondary endpoints (pain, fatigue, and sleep) were measured using the Functional Assessment of Cancer Therapy-Breast version 4.0 (FACT-Bv4.0) and the Numerical Rating Scale at 4 time points (i.e., pre-surgery and 1, 3, and 6 months post-surgery).

我们招募了乳腺癌患者，并将他们随机分配到干预组(n=56)和对照组(n=55)。前者接受以微信为基础的多模式护理方案（见Table1）加常规护理6个月，后者仅接受常规护理。主要结局指标(与健康相关的生活质量)和次要结局指标(疼痛、疲劳和睡眠)在4个时间点(即术前、术后1、3和6个月)使用癌症治疗功能评估-乳房版本4.0(FACT-Bv4.0)和数字评定量表进行测量。

Results 研究结果

The intervention group had significantly improved total FACT-Bv4.0 scores owing to the effects of group (F = 16.28, P < 0.001), time (F = 28.82, P < 0.001), and group-time interaction (F = 5.35, P = 0.001). Similar improvements were also found in social/family well-being and functional well-being (P < 0.05). Emotional well-being was improved based on the effects of time (F = 42.12, P < 0.001) and group-time interaction (F = 10.20, P < 0.001). The 'breast cancer-specific subscale for additional concerns’ was affected by group (F = 21.55, P < 0.001) and time (F = 28.96, P < 0.001), whereas physical well-being was only affected by time (F = 35.39, P < 0.001). Pain, fatigue, and sleep were not significantly influenced by group effects.

干预组FACT-Bv4.0总分在组(F=16.28，P<0.001)、时间(F=28.82，P<0.001)和组-时间交互作用(F=5.35，P=0.001)方面均有显著提高。在社会/家庭幸福感和功能幸福感方面也有类似的改善(P<0.05)。情绪幸福感在时间(F=42.12P<0.001)和组-时间交互作用(F=10.20，P<0.001)的影响下得到改善。“额外关注的乳腺癌特异性分量表”受组(F=21.55P<0.001)和时间(F=28.96P<0.001)的影响，而身体幸福感仅受时间(F=35.39P<0.001)的影响。疼痛、疲劳和睡眠不受组效应的显著影响。

Conclusions 研究结论

We found a significant improvement in the health-related quality of life of postoperative women with breast cancer who used the WeChat-based multimodal nursing program during early rehabilitation. This demonstrated that the program is an effective intervention for postoperative rehabilitation in such patients. Findings of the study will provide evidence for eHealth services in clinical and transitional nursing care.

我们发现在早期康复期间使用基于微信的多模式护理方案的乳腺癌术后妇女的健康相关生活质量有显著改善。这表明该方案是对此类患者术后康复的有效干预措施。研究结果将为电子健康服务在临床和过渡性护理中的应用提供依据。