The Development of a Self-care Promoting Model for Breast Cancer Patients to Prevent Unplanned Re-visiting at the Surgical Outpatient Department at Nakhon Pathom Hospital

Abstract

This research and development design research aimed to: 1) develop a self-care promoting model for breast cancer patients to prevent unplanned re-visits, 2) determine the effects of the model implemented on the level of the perception of breast cancer patients regarding compliance with self-care promotion and the unplanned re-visiting rate. and 3) study the satisfaction of the breast cancer patients and registered nurses who participated in the program. This study was divided into following 3 steps.  Step one was the analysis of the situations and the roles of registered nurses regarding promoting self-care behavior among breast cancer patients. Groups of 12 multidisciplinary health care providers and 6 breast cancer patients and their caregivers were recruited to collect data via group discussions.   Step two was the development of the self-care promotion model for breast cancer patients based on the situations and important issues discovered in the first step and empirical evidence. The quality of the promotion model guidelines was evaluated in accordance with the AGREE II criteria by three experts; the overall quality was 95.1%. The model was then trialed with six breast cancer patients, three who had, and three who did not have caregivers, and revised.  The third steps was the implementation of the model  with 30 participants, 15 breast cancer patients with caregivers and 15 breast cancer patients without caregivers by five registered nurses.  Data was collected using semi-structured questions in group discussions to evaluate the model, a nursing behavior perception in helping patients of professional nurses questionnaire, a form to assess the breast cancer patients’ and professional nurses’ satisfaction with the model, and the records of patients re-visiting at the out-patient department. The quality of the questionnaire was assessed by using the content validity index and was 0.96. The  Cronbach alpha coefficient showed an acceptable reliability of 0.85. The data were analyzed using descriptive statistics, Chi-squared tests, and Wilcoxon signed rank tests.

            Applying the model to both groups of breast cancer patients yielded the following five findings. First, the satisfaction scores of both groups increased significantly after the model was implemented. Second, the difference in the increase of satisfaction of the two groups was not statistically different (p >.05). Third, the perception scores of both groups of breast cancer patients’ caregivers’ increased statistically significantly  (p < .05). Fourth, the registered nurses’ satisfaction was statistically significantly higher (p < .05). Fifth, there were no unplanned re-visits among the patients who participated in the study. The findings suggested that the self-care promotion model for breast cancer patients to prevent unplanned outpatient re-visits outpatient that was developed should continue to be used in the out-patient department.