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ORIGINAL ARTICLE
Year : 2018  |  Volume : 14  |  Issue : 8  |  Page : 202-207

Effects of continued psychological care toward brain tumor patients and their family members' negative emotions


1 Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha 410078; Department of Nursing, PLA 169 Hospital, Hengyang 421002, Hunan Province, China
2 Department of Nursing, PLA 169 Hospital, Hengyang 421002, Hunan Province, China
3 Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha 410078, China

Date of Web Publication26-Mar-2018

Correspondence Address:
Shuiyuan Xiao
School of Public Health, Central South University, Changsha 410078, Hunan Province
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.181184

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 > Abstract 


Purpose: Numerous studies have confirmed that brain tumor patients and their family members frequently exhibit negative emotional reactions, such as anxiety and depression, during diagnosis and treatment of the disease. Family members experience increasing pressure as the year of survival of patient progress. The aim of this study was to investigate the effects of the continued psychological care (CPC) toward the brain tumor patients and their family members' emotions.
Subjects and Methods: The asynchronous clinical control trial was performed, and 162 brain tumor patients and their family members were divided into the control group and the intervention group. The control group was only performed the telephone follow-up toward the patients. Beside this way, the intervention group was performed the CPC toward the patients and their family member. The self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) were used to measure the negative emotions of the patients and their family members, and the patients' treatment compliance and the incidence of seizures were compared.
Results: The SAS and SDS scores of the intervention group on the 14 days, 28 days and 3 months of the CPC were significantly lower than the control group (P < 0.05); the SAS and SDS scores of the intervention group after the intervention were significantly lower than those at the discharging (P < 0.05), the treatment compliance of the intervention group was significantly higher than the control group (P < 0.05), and the seizure incidence of the intervention group was significantly lower than the control group (P < 0.05).
Conclusion: The CPC could effectively reduce the anxiety and depression among the brain tumor patients and their family members.

Keywords: Brain tumor, continued care, continued psychological care, patients, patient's family members


How to cite this article:
Xiao N, Zhu D, Xiao S. Effects of continued psychological care toward brain tumor patients and their family members' negative emotions. J Can Res Ther 2018;14, Suppl S1:202-7

How to cite this URL:
Xiao N, Zhu D, Xiao S. Effects of continued psychological care toward brain tumor patients and their family members' negative emotions. J Can Res Ther [serial online] 2018 [cited 2019 Jun 26];14:202-7. Available from: http://www.cancerjournal.net/text.asp?2018/14/8/202/181184




 > Introduction Top


The survival rate of the brain tumor patients has improved during the last 30 years; according to statistics from 1995 to 2001, the survival years of level I/II cancer patients (World Health Organization Classification of Brain Tumors) is 2 years to 10 years, whereas that of level III/IV cancer patients reaches 1 year.[1] Family members of brain tumor patients act as caregivers not only when the patient is in the hospital, but also after the patient is discharged. Thus, family members experience increasing pressure as the year of survival of patient progress. Numerous studies have confirmed that brain tumor patients and their family members frequently exhibit negative emotional reactions, such as anxiety and depression, during diagnosis and treatment of the disease.[2] Most patients and their family members wish to avail of professional care after the patient is discharged from the hospital; however, patient needs are frequently difficult to fulfill. Continued care involves using information tools, such as telephones, letters, e-mails, and personal visits from health care providers, among others. This process can effectively improve the quality of life of patients after they are discharged from the hospital. Focused interaction can be established between health care providers and patients, as well as their family members, and thus patient health is promoted and maintained.[3] Psychological care is a nursing process that is guided by psychology theories and is based on good interpersonal relationships. In this process, nurses interact and communicate with patients, thus influencing and changing their psychological state and behavior. Such process provides the best effect in medical care. In the present research, continued psychological care (CPC) was provided to 162 brain tumor patients and their family members. The results revealed that CPC has an important role in relieving the negative emotions of patients and their family members.


 > Subjects and Methods Top


Subjects

Brain tumor patients, who were discharged from a particular 3A hospital from October 2011 to September 2013, as well as their family members, were selected as subjects for the study. The inclusion criteria were as follows: (1) The patients and their family members were all >18 years old. (2) The patients and their family members had an educational level higher than that of primary education. They should be capable of oral and written communication, and should agree to participate in the study. (3) Radiologic examination had revealed the presence of occupying lesions, and brain surgeons had already performed craniotomy. (4) The patients and their family members should have no previous history of mental illness and no serious physical illness in other organ systems during the start of the study. A total of 162 brain tumor patients discharged from the hospital as well as their family members were included in the study (patient: Family member ratio = 1:1). The family members selected for the study were either the parents, spouse or children of the patient. The spouse was the first choice, followed by the children, and then, the parents. Moreover, the selected family member should be the primary caregiver of the patient. An asynchronous clinical trial was conducted. Patients discharged from October 2011 to September 2012, as well as their family members were designated as the control group. A total of 92 brain tumor patients were discharged from the hospital during that period, and 84 patients with 84 family members satisfied the inclusion criteria. The patients discharged from October 2012 to September 2013, as well as their family members were assigned as the intervention group. A total of 89 brain tumor patients were discharged from the hospital during that period, and 78 patients with 78 family members satisfied the inclusion criteria. This study was conducted in accordance with the Declaration of Helsinki. This study was conducted with approval from the Ethics Committee of Central South University. Written informed consent was obtained from all patients and their family members.

Developing a Health Monitoring Handbook for Brain Tumor Patients

The handbook included health guidelines for brain tumor patients. A table was used for recording the daily medication, exercise activities, symptoms, seizure incidence, and reconsultation schedule of the patient. Those who satisfy the requirements of the health guidelines were checked, whereas those who did not were crossed.

Developing a continued care training program for brain tumor patients

The training included providing information on the brain tumor, as well as discussing the contents and requirements of continued care, health guidelines, applications of the Health Monitoring Handbook for Brain Tumor Patients, professional ethics, service concepts, etiquette training, communication skills, and psychology-related knowledge.

Establishing the continued care team

The team consisted of four senior nurses with comprehensive expertise and effective communication skills. Registration for the CPC team was voluntary, and the registrants should pass the examination for brain tumor CPC training. Those who passed the examination were then assigned to provide one-on-one CPC to brain tumor patients as their next assignment.

Intervention

When the patients in the control group were discharged, the nurses in charge explained the health guidelines to the patients and their family members. The nurses also guided them in filling in the Health Monitoring Handbook for Brain Tumor Patients. The contact information of the patients was recorded. Routine telephone interviews on the 7th, 14th, and 28th day after discharge were conducted. Monthly follow-ups were performed for the first 3 months, and then, twice a year thereafter. During routine telephone interviews, the general health condition, symptoms, medications, seizure incidence, and rehabilitation training, etc., of the patients were asked. The patients were also given health education and guidance in rehabilitation. Finally, they were reminded of their next consultation schedule.

On the discharge of patients in the intervention group, a designated CPC member communicated with the patients and their family members, and informed them of the objective, type, period, and contents of CPC. The CPC protocol was then signed voluntarily. The team members first provided health guidelines to the patients, directing them, and their family members to fill in the Health Monitoring Handbook for Brain Tumor Patients. Then, the team members recorded the contact information of the patients and their family members. CPC members conducted routine telephone interviews with the patients and their family members on the 6th, 13th, and 27th day after discharge. Monthly follow-ups were performed for the first 3 months after discharge, and then, semi-annually thereafter. The general health condition, subjective symptoms, medications, seizure incidence, and rehabilitation training of the patients were determined, as well as the psychological feeling of the patients and their family members. After the telephone interviews, individualized care plans were developed according to conditions of the patients and their family members. Moreover, home visits were made on the 2nd day after the telephone interviews to provide psychological support and counseling.

General information questionnaire

The questionnaire primarily included the gender, age, educational level, marital status, and medical expenses of the patients and their family members.

Self-rating anxiety scale and self-rating depression scale

Each scale has 20 items that are divided into four-grade scores to assess the subjective feelings of anxiety and depression of patients and their family members. The evaluation criteria are as follows. A self-rating anxiety scale (SAS) standard score >50 points indicates anxiety symptoms, whereas a score >62 points indicates severe anxiety symptoms.[4] Meanwhile, a self-rating depression scale (SDS) standard score >53 points indicates depression symptoms, whereas a score >70 points indicates severe depression symptoms.[4] The evaluation was performed on the patients and their family members after the 14th and 28th day, and 3rd month telephone interviews for the control group. For the intervention group, evaluation was performed on the patients and their family members after the 14th and 28th day, and 3rd month home visits.

Treatment compliance evaluation form

A year after the patients in the two groups were discharged, data, reconsultation data, and follow-up data of the patients (i.e., the Health Monitoring Handbook for Brain Tumor Patients) were collected and analyzed. The self-developed treatment compliance and seizure incidence evaluation table were used to compare the situations of the patients in the two groups. The table included three aspects, with a total of 12 items. The total score was nine points: 4 points for treatment compliance, 4 points for seizure incidence, and 1 point for regular reconsultation compliance. The detailed information is provided in [Table 1].
Table 1: Point assignment information of medication compliance and seizure situation evaluation table toward brain tumor patients

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Statistical analysis

Microsoft Excel and SPSS 13.0 (SPSS Inc., Chicago, USA) statistical software were used for data processing. The statistical methods used included descriptive statistics, U test, and χ2 test. P<0.05 was considered as significantly different.


 > Results Top


General information

No significant difference was found regarding gender, age, educational level, and marital status between the two groups [Table 2], (P > 0.05).
Table 2: General information of the brain tumor patients and their family members n (%)

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Comparing the self-rating anxiety scale and self-rating depression scale scores of patients before and after continued psychological care implementation

No significant difference in SAS and SDS scores between the two groups (P > 0.05) was observed on discharge. On the 14th day, 28th day, and 3rd month of CPC implementation, the SAS and SDS scores of the intervention group were significantly lower than those on discharge (P < 0.05). The SAS and SDS scores of the intervention group were also significantly lower than those of the control group (P < 0.05). On the 14th day, 28th day, and 3rd month, the SAS and SDS scores of the control group exhibited no significant difference with those on discharge [Table 3], (P > 0.05).
Table 3: Self-rating anxiety scale and self-rating depression scale scores of the two groups' patients before and after the continued psychological care implementation

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Comparing the self-rating anxiety scale and self-rating depression scale scores of the family members of patients before and after continued psychological care implementation

No significant difference in SAS and SDS scores was found between the two groups of family members on discharge (P > 0.05). On the 14th day, 28th day, and 3rd month after CPC implementation, the SAS and SDS scores of the intervention group were significantly lower than those on discharge (P < 0.05). The SAS and SDS scores of the intervention group were also significantly lower than those of the control group (P < 0.05). On the 14th day, 28th day, and 3rd month, the SAS and SDS scores of the control group exhibited no significant difference with those on discharge [Table 4], (P > 0.05).
Table 4: Self-rating anxiety scale and self-rating depression scale scores of the two groups' family members before and after continued psychological care implementation

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Comparing treatment compliance and seizure incidence of patients before and after continued psychological care implementation

After CPC implementation, the scores for treatment compliance, seizure incidence, and regular reconsultation compliance of the intervention group were significantly higher than those of the control group [Table 5], (P < 0.05).
Table 5: Scores of treatment compliance and seizure incidence of the two groups

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 > Discussion Top


Continued care was introduced in the experimental study of the Pennsylvania School of Nursing in 1998.[5] The philosophy of continued care was proposed by Brooten et al. of the University of Pennsylvania in 2002; it refers to nursing care provided during the transfer from hospital to home.[6] The American Geriatrics Society defined continued care as “care that ensures that the patient will obtain different levels of collaborative and continuous care from different health-care facilities (such as from hospital to home) and from the same health-care facility (such as different departments of the hospital) through a series of designed actions.” Continued care generally refers to the continuity of care from hospital to home, including the discharge plan developed by the hospital, the transfer of treatment, and continuous follow-up and guidance after the patient returned to his/her home, or community.[7] Other scholars described the meaning of continuity from three different dimensions. The first dimension is the continuity of the information of the patient, which ensures the accuracy of information during treatment and transfer among different medical institutes. The second dimension is the continuity of health care services throughout the entire health service system. That is, patients should always be ensured of continuous health care. The third dimension is the continuity of doctor–nurse–patient relationship. That is, the continuity of the loyal and trusting relationship among doctors, nurses, and patients when the latter receive services provided by different health-care providers.[8]

In the past, the discharge of a patient from a hospital typically meant the end of the relationship between the patient and the hospital. The patient then returns to the hospital for related rehabilitation information, and satisfying the requests of the patient is sometimes difficult. Studies have shown that although the majority of health problems of patients can be solved during hospitalization, many patients still experience various degrees of health problems at home. Thus, continued treatment after discharge is important. Patients and their family members are becoming increasingly demanding with regard to knowledge on self-conditioning, disease observation, and health care after discharge; therefore, an increasing trend in continued services at home was observed.[9] Thus, patients still have a high demand for health care after discharge, and consequently, most patients still require continued care after discharge. At present, continued care is applied in managing diabetes, chronic kidney diseases, breast cancer, colorectal cancer, and other diseases; this form of health care has achieved good results.[10],[11],[12] CPC is a type of continued care that including psychological support and counseling. In current societies, the status of psychological and psychiatric problems has gradually improved and has received increasing attention in our country.[13] After discharge, patients and their family members will encounter psychological problems. CPC can provide them with specific guidance based on the illness recovery situation of the patients. CPC also addresses concerns during the rehabilitation process and provides psychological support and counseling to patients and their family members. Thus, patients and their family members will be confident while performing rehabilitation training, and thus, healing of the disease is promoted. In this research, CPC was provided to brain tumor patients and their families after discharge. CPC effectively reduced the negative emotions of the patients and their family members, improved the treatment compliance of the patients, and reduced the incidence of seizures. Therefore, CPC is feasible and should be implemented.

Tumor is a severely negative life event. Patients with tumors experience severe anxiety and depression reactions, thereby affecting the prognosis and outcome of the disease as well as reducing the quality of life of the patient.[13] Modern psychosomatic medicine has proven that physical illnesses can lead to emotional disorders, such as anxiety, sadness, and fear.[14] These emotional disorders can aggravate the physical disease through reactions in the brain cortex center. Tension stimulates the growth and development of tumor, and an adverse psychological status aggravates the adverse reactions of the treatment, which significantly affects the quality of life of cancer patients. In this study, trained and qualified nurses formed the CPC team. They performed one-on-one continued care for patients and their family members. The basic information of the patients and their family members was obtained through telephone interviews. Appropriate nursing interventions were then developed, and home visits were made to observe the psychological status of the patients and their family members. CPC members comprehensively understood the needs of the patients and their family members and specifically explained disease-related knowledge. They also provided psychological support and counseling. The results of our study showed that no significant difference was found in the SAS and SDS scores between the two groups on discharge (P > 0.05). On the 14th day, 28th day, and 3rd month of CPC implementation, the SAS and SDS scores of the intervention group were significantly lower than those on discharge (P < 0.05). The SAS and SDS scores of the intervention group were also significantly lower than those of the control group (P < 0.05). On the 14th day, 28th day, and 3rd month, the SAS and SDS scores of the control group exhibited no significant difference i th those on discharge (P > 0.05). After CPC implementation, the scores for treatment compliance, seizure incidence, and regular reconsultation compliance of the intervention group were significantly higher than those of the control group (P < 0.05). This finding indicates that CPC implementation enabled the patients and their family members to understand and accept the situation of the patients, to not feel afraid of the disease, and to have confidence on its prognosis. The results showed that anxiety and depression were effectively reduced among the patients and their family members. Treatment and reconsultation compliance were significantly improved, and seizure incidence was also effectively controlled. These improvements will be conducive to the prognosis of the disease. Our results are consistent with those of previous studies [15],[16],[17] thus indicating the feasibility of our study. CPC implementation can relieve anxiety and depression in both brain tumor patients and their family members.

Continued care, which is based on theories of human care and holistic nursing, can satisfy the needs of discharged patients. This procedure expands medical care services beyond hospitalization, including treatment, and rehabilitation after discharge. By adopting appropriate strategies, research on and practice of continued care can improve information exchange and transmission, strengthen follow-ups, and promote an effective interface among health-care services.[18] At present, continued care is regarded as a priority outcome of health-care services, and the process has been studied only at a limited level from the perspective of patients.[19] Furthermore, effective measures for enlisting family members in care planning remain lacking. Therefore, the roles of the family members of patients in the care process should be further extended and defined.[18] CPC is part of continued care but is rarely studied locally and abroad. Further studies should be conducted to make this case mode a part of hospital work and to institutionalize and standardize continued care for effective implementation.


 > Conclusion Top


CPC can effectively reduce anxiety and depression among brain tumor patients and their family members. CPC should be further studied to provide an evidence-based foundation to implement continued care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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