Qualitative study of continuing nursing needs in patients with precision radiotherapy for nasopharyngeal carcinoma

To explore the inner feelings and experiences of patients with precision radiotherapy for nasopharyngeal carcinoma after discharge on continue nursing needs, and to provide theoretical basis for the development of continuing nursing service for patients with nasopharyngeal carcinoma.


| INTRODUCTION
Nasopharyngeal carcinoma (NPC) is a malignant tumor that occurs on the top and side walls of the nasopharynx. Eighty percent cases of NPC occurred in the world were found in China. 1,2 At present, the most commonly medical intervention is comprehensive treatment that includes precision radiotherapy and supplementary therapy combined with chemotherapy and targeted therapy. NPC patients have high rate of occurrence of radiotherapy-induced acute skin and oral reactions which persisted or could be even worsened during and postradiotherapy, and radiation-related severe late complications such as neck fibrosis and trismus and xerostomia. [3][4][5] Continuity of care refers to service offered to discharge patients in need of further medical assistant to care for their life, to promote rehabilitation, and give health guidance as an extension of inpatient care service. 6 It is shown that continuity of care given to NPC patients with radiotherapy has effectively improved patients' compliance of rehabilitation training to prevent trismus and contribute to a lower incidence of trismus. In the meantime, the patients have been benefited from better functional rehabilitation. 7,8 Most of domestic researches on continuity of care for NPC patients used quantitative research methods and rarely touched on the nursing needs from the perspective of patients. Qualitative research which is highly sensitive to the patient's subjective feelings and world view can be used to express true experience of NPC patients about their disease and health. 9 This study used qualitative research methods to understand the health needs after discharge of NPC patients through in-depth interviews to provide reference for the development of continuity of care service.

| Participant
By using purposive sampling method, untreated NPC patients who were hospitalized in Jiangsu Cancer Hospital from January to December in 2018 were interviewed. Sample size of the study was determined by the principle of data saturation which means when the content of interviews no longer included any new topic; the data reached its saturation. [10][11][12]

| Research ethics
Before the interview, the purpose, significance, procedure, method of data collection, treatment and the presentation of the research was explained to the participants, and audio and video recordings were authorized by participants and Informed Consent Form were signed.
During the interview, no inducement or intervention were applied upon the participants (patients). All the answers and behaviors of participants were objectively recorded to minimize the bias. To protect participants privacy, all the data collected during this research were anonymized and managed carefully.

| Data arrangement and analysis methods
Data arrangement method: After the interview, the interview records of each participant are encoded from to A-J, and independent files are created. A textual transcription of the recorded material was made in time. 13

T A B L E 1
General information of participants (n = 10) and refine the commonalities in the researcher's language to form the subject and theme group of the study; (g) Return to the participant to verify. In this study, these steps were performed for treatment analysis and jointly explored the extracted themes, until a consensus is reached.

| The rigor of research
Representativeness of the subjects were fully considered. After the interview, the observation situation was recalled by the researchers and the recording was listened repeatedly, and converted the interview data into written text within 24 hours. Then, the written results were sent back to the participants to further verify the accuracy and authenticity of the content.

| RESULTS
After data analysis, four themes were generated.
3.1 | Theme 1: Expectation of disease prognosis and self-care related knowledge All 10 patients showed strong demands on medical information, and they hoped to get guidance and assistance from medical staff, including prognosis of disease and self-care knowledge after treatment.
Self-management strategies on side effects of radiotherapy and chemotherapy, especially knowledge of radiation-induced dermatitis, radiation-induced oral mucositis, and exercises to prevent trismus, and so on. Case A: " I heard the process of radiotherapy is very painful and people will be roasted. As reported, nearly 100% of patients wish to get health education related to their own disease treatment, which is consistent with the results of this study. 12 The study found that education on self-care knowledge and methods were significantly inadequate and limited, and patients cannot respond to and deal with mental and physical problems after their discharge. This result suggests that more atten-  and their needs of medial information should be met to improve their self-management compliance.

| CONCLUSION
The study showed that patients have a higher level of demand for continuity of care, and that the change in demand is affected by many factors. [21][22][23] In this study, we conducted an in-depth interview among 10 discharged NPC patients by qualitative analysis. For the purpose of objectively presenting their demand for continuity of care after discharge, and afterwards, four themes were extracted. The results of the study can help medical staff provide medical care support, human care and customized extended care service to meet the changing physiological, psychological and social needs of patients to improve their quality of life. However, the sample size in this study is limited in amount, so the conclusion after the interviews can only partially reveal experience(s) of the participants, which may affect the generalization of the results, and further development is needed in the theme extraction. In the future work, more quantitative researches and analyses will be carried out on the basis of the results of qualitative research obtained in this study in order to explore need of continuity of care for patients with NPC at different ages and disease progression to better guide nursing work.

CONFLICT OF INTEREST
The authors have no conflicts of interest to declare.

AUTHOR CONTRIBUTIONS
XL: survey concept and design; assisting in collecting and analyzing data; manuscript preparation and review JL: assisted in survey concept; assisted in analyzing data SL: assisted in survey concept and design; manuscript review YW: assisted in collecting and analyzing data DX: survey concept and design; manuscript review

ETHICS STATEMENT
The study was approved by the Jiangsu Cancer Hospital Ethics Committee and all patients gave written informed consent.