2.1 Object Patients with advanced breast cancer who were hospitalized in the department of breast oncology of our hospital from October 2019 to April 2020 were selected. They were divided into control group and observation group with 40 cases each, and are all females with aged between 22 and 65 years.
Major grouping criteria 1). A female with an age ≥ 18 years old, recurrent metastatic breast cancer was confirmed by pathology or imaging; 2) The client who has received an effective standardized treatment plan for cancer pain and the treatment is effective; 3) The client who possesses normal cognitive function, able to understand and answer questions correctly; 4) The numeric pain rating scale (NRS) which is used to measure the clinical pain has been used in our study. Clients are instructed by the nurse to choose a single number by using the NRS that best indicates their level of pain. The NRS score of 0/10 indicates no pain, 1-3/10 indicates mild pain, whilst 4-6/10 indicates moderate pain, and 7-10/10 indicates severe pain that the clients may unable to fall asleep or wakening from sleep [5].
Exclusion criteria 1). Existence of life-threatening situations of visceral and/or meningeal metastases; 2). Pain associated with other non-malignant tumors; 3). Clients with cognitive impairment; 4). The clients with a score of Barthel Index for activities of daily living (ADL) below 70 [6].
In addition, all the included clients were confirmed as breast cancer by pathology, accompanied by varying degrees of cancer pain during hospitalization, and received pain treatment. There was no significant differences in gender, age, education and disease between the two groups (P>0.05).
2.2 Method
2.2.1 Control group The patients were followed up by telephone according to the pain follow-up schedule in the conventional nurse-patient communication mode, and corresponding answers were given when the patients raised questions.
2.2.2 Observation group On the basis of routine telephone follow-up, the standardized terminology communication chart (see table 1) was adopted for telephone follow-up. The specific method is as follows:
2.2.2.1 Setting up 2 pain specialist team leaders, headed by the head nurse, ensuring each department has at least one pain nurse who has worked in the department of oncology for more than 5 years and is good at communication, and will be trained once a month. The training includes telephone follow-up procedures, polite language, pain expertise (assessment tools, methods and content), adverse drug reactions and management, pain outbreak observation and management, pain relief methods, control goals, follow-up hotline questions, and case scenario drills. We simulated and designed various telephone follow-up scenarios, with a group of three people who acting as a tutor, a nurse and a patient. Through the competition, the theoretical knowledge of pain nursing can be transformed into clinical practice. By practicing the "role transformation", the nurse presents empathy and easily to understand the health issues from the perspective of the patient. The nurse who passes both the scenario simulation exercise and the theoretical examination can be qualified.
2.2.2.2 Establishing of discharge follow-up file of patients with cancer pain: 1). The patients’ general condition, pain location, quality, intensity, and scores (by using the NRS); 2). The patient's medication status, including the name, dosage, usage and adverse reactions of analgesics; 3). Treatment of drugs’ adverse reactions; 4). Treatment of outbreak pain; 5). Satisfaction of pain control.
Table 1 Glossary of standard terms of patient telephone follow-up for pain nurses
2.2.2.3 Follow-up time: Follow-up was conducted by telephone every Monday afternoon and completed within one week after discharge. For the patients with NRS score ≥3 points were followed up again within three days and to guide them how to adjust the drug dose; For the patients with NRS score ≥3 points lasting for three consecutive follow-up visits are recommended to return to the hospital for treatment; For the patients with effectively controlled pain by three consecutive follow-up visits, it were changed to one monthly visit for a total of 3 months.
2.2.3 Observational index The total scores of self-pain monitoring, treatment compliance, diet management, adverse reaction management and self-management ability of the two groups have been observed. Likert Scale is a psychological measurement which based on the principle of asking people to give their response by choosing among a series of statements concerning a given topic. Through the respondents’ answers in terms of extent to which they agreed or disagreed, this can reflect their cognitive and affective attitude. [7] There are 23 items of the given topics in total by using the Likert Scale. The corresponding scores are 23-161 in the scale that ranging from ‘Strong agree’ to ‘strong disagree’ [8]. The higher scores mean the better self-management skills. In terms of the satisfaction of telephone follow-up, the satisfaction questionnaire of nursing service for patients with cancer pain designed by our department has been used. The survey includes 7 items: Whether the patients can correctly grade the pain scores by using the NRS; Patients’ attitude to telephone follow-up personnel service; Satisfaction with the medication instruction which was provided by the nurse; Satisfaction with the answers to adverse reactions and precautions; The attitude towards the answers about how to cope with the pain; Attitude towards the help with the pain control; Overall satisfaction with the telephone follow-up and so on. The survey’s full score is 100, while the scores>95 indicate highly satisfactory, the scores between 90 and 95 means the patients felt satisfied, the scores between 80 and 90 means ordinary, however, the scores below 80 means unsatisfied. Degree of satisfaction (%) = Highly satisfactory ratio (%) + Basic satisfactory ratio (%).
2.2.4 Statistical approach data input software SPSS20.0 was used for statistical analysis. The measurement data are subject to t test, while the counting data were tested with X2 text; They are expressed as (mean ± standard deviation) and percentage respectively. P<0.05, which means the difference was statistically significant.