中低位直肠癌保肛术后LARS病人过渡期康复行为建立的促进与阻碍因素研究

    Rehabilitation behaviors in LARS patients: a study on facilitators and barriers during the transitional period following sphincter-preserving surgery

    • 摘要:
      目的: 探讨直肠癌保肛术后低位直肠前切综合征(low anterior resection syndrome,LARS)病人出院后至居家康复稳定阶段康复行为建立的促进与阻碍因素。
      方法: 采用便利抽样,选取2024年6—10月21例直肠癌保肛术后LARS病人进行半结构式访谈,基于COM–B理论模型,运用现象学研究方法,资料通过Colaizzi 7步分析法,进行分析、归纳并提炼主题。
      结果: 过渡期康复行为的促进因素包括:(1)机会因素,专业医疗护理支持、多元的社会支持;(2)动机因素,康复益处的感知、积极的肠道症状自我管理能力,积极的价值信念。阻碍因素包括:(1)能力因素,信息不对称与专业壁垒、症状压力,康复知识缺乏;(2)机会因素,不利康复的环境、经济负担、角色行为限制;(3)动机因素,癌症复发的恐惧、运动回避。
      结论: 在中低位直肠癌保肛术后LARS病人过渡期间,应给予科学的专业护理知识、多元的社会资源支持,帮助其树立积极的价值信念和提升自护能力,同时营造良好的康复环境,将有助于病人建立正确的康复行为,提高康复依从性。

       

      Abstract: Objective: To explore the facilitating and hindering factors for the establishment of rehabilitation behaviors in patients with low anterior resection syndrome (LARS) after anal-preserving surgery for rectal cancer from discharge to the stable phase of home-based rehabilitation. Methods: Using convenience sampling, 21 patients with LARS who underwent anal-preserving surgery for rectal cancer from June to October 2024 were selected for semi-structured interviews. Based on the COM-B theoretical model, phenomenological research methods were employed, and the data were analyzed, summarized, and themes were extracted using the Colaizzi 7-step analysis method. Results: The facilitating factors for rehabilitation behaviors during the transition period included: (1) opportunity factors, such as professional medical care support and diverse social support; (2) motivation factors, such as perception of rehabilitation benefits, positive self-management ability for intestinal symptoms, and positive value beliefs. The hindering factors included: (1) ability factors, such as information asymmetry and professional barriers, symptom stress, and lack of rehabilitation knowledge; (2) opportunity factors, such as unfavorable rehabilitation environments, economic burdens, and role behavior restrictions; (3) motivation factors, such as fear of cancer recurrence and avoidance of exercise. Conclusion: During the transition period of patients with LARS after undergoing anal-preserving surgery for middle and low rectal cancer, scientific professional nursing knowledge and diverse social resource support should be provided to help them establish positive value beliefs and enhance self-care abilities. At the same time, creating a favorable rehabilitation environment will assist patients in establishing correct rehabilitation behaviors and improving rehabilitation compliance.

       

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