Development of care model for the risk group of aspiration pneumonia based on a predictive scoring system in advanced head and neck cancer patients undergoing concurrent chemoradiotherapy.

Abstract

Abstract

This research and development study aimed to examine the situation, develop, and evaluate the effectiveness of a care model for individuals at risk of aspiration pneumonia based on predictive scoring criteria among patients with advanced head and neck cancer receiving radiotherapy and chemotherapy. The study was conducted in three phases: (1) situation analysis, (2) care model development, and (3) evaluation of the model’s effectiveness. Phase 1 involved a review of 260 patient medical records. In Phase 3, purposive sampling was used to select the participants, including: (1) 36 patients in the experimental group and 36 in the control group, all diagnosed with advanced head and neck cancer undergoing radiotherapy and chemotherapy, and (2) 17 registered nurses. The research instruments consisted of: (1) predictive scoring criteria for identifying at-risk patients, (2) a nursing care model manual, and (3) a self-care manual for patients, with IOC values of 0.96, 0.96, and 0.98, respectively. Data collection tools included: a patient information record form for Phase 1 (IOC = 1.00); a self-care knowledge assessment for patients at risk of aspiration pneumonia (IOC = 0.98; Cronbach’s alpha = 0.75); and a nurse questionnaire evaluating the usefulness of the care model (IOC = 0.98; Cronbach’s alpha = 0.95). Descriptive statistics were used to analyze general data. Risk factors were analyzed using Chi-square and stepwise methods. Differences between groups were tested using the Wilcoxon signed-rank test.

The findings revealed that age, performance status (ECOG), body mass index, alcohol consumption, oral hygiene, tumor location, Carboplatin-based chemotherapy regimen, and tube feeding were significantly associated with the occurrence of aspiration pneumonia (p < 0.05). The developed care model consisted of two components: (1) a nursing care model manual, and (2) a patient/caregiver self-care manual. Evaluation of the model’s effectiveness showed that although the incidence of aspiration pneumonia decreased, the reduction was not statistically significant (p = .96). However, the severity of aspiration pneumonia—particularly moderate to severe cases—and the average duration of radiotherapy were significantly reduced (p < .05 and p < .001, respectively). Additionally, patient/caregiver self-care knowledge scores increased significantly (p < .001). Nurses also strongly agreed that the care model was beneficia