Application and effect evaluation of case management nursing practice mode in patients with precision radiotherapy for nasopharyngeal carcinoma

To explore the application and effect evaluation of case management nursing practice mode in patients with nasopharyngeal carcinoma receiving precision radiotherapy. Fifty patients with nasopharyngeal carcinoma diagnosed for the initial treatment in our hospital from February 2020 to October 2020 were selected as the control group and 50 patients with the same condition in the same period were selected as the experimental group. The experimental group was trained by nurses to implement case management nursing practice mode for nasopharyngeal cancer patients; in the control group, nasopharyngeal cancer patients were treated with general nursing routine, such as health education and discharge guidance before chemotherapy and radiotherapy. Compared with the control group, self‐care ability and patient satisfaction of experimental group were improved to a certain extent, and the differences were statistically significant (p < .05). The nursing practice mode of case management is suitable for patients with cancer and chronic diseases. The mode can provide continuous and high‐quality nursing for patients, improve patients' self‐care ability, satisfaction with hospitalization, and so forth, and thus is worthy of clinical application.


Abstract
To explore the application and effect evaluation of case management nursing practice mode in patients with nasopharyngeal carcinoma receiving precision radiotherapy. Fifty patients with nasopharyngeal carcinoma diagnosed for the initial treatment in our hospital from February 2020 to October 2020 were selected as the control group and 50 patients with the same condition in the same period were selected as the experimental group. The experimental group was trained by nurses to implement case management nursing practice mode for nasopharyngeal cancer patients; in the control group, nasopharyngeal cancer patients were treated with general nursing routine, such as health education and discharge guidance before chemotherapy and radiotherapy. Compared with the control group, self-care ability and patient satisfaction of experimental group were improved to a certain extent, and the differences were statistically significant (p < .05). The nursing practice mode of case management is suitable for patients with cancer and chronic diseases. The mode can provide continuous and high-quality nursing for patients, improve patients' self-care ability, satisfaction with hospitalization, and so forth, and thus is worthy of clinical application.

K E Y W O R D S
case management, nasopharyngeal carcinoma, satisfaction, self-care ability Nasopharyngeal carcinoma is a malignant tumor occurring at the apex and lateral wall of the nasopharyngeal cavity. According to the WTO investigation, 80% of nasopharyngeal carcinoma in the world occurs in China, especially in southern China. 1 With the rapid development of the integration of medical resources, the survival rate of patients has been continuously improved, but a variety of acute and chronic side effects also appear, such as skin and oral mucosa reaction, limited mouth opening, permanent dry mouth, which reduce the patients' comfort, increase sadness and anxiety during hospitalization and after discharge in a long time, seriously affect the life quality of patients. 2 Case management is a working mode of providing systematic care services for patients in combination with various professional fields of the hospital. It is case centered and emphasizes continuity and comprehensiveness.
According to the disease characteristics and personalized needs of patients, it provides integrated care for patients in a team way through communication, coordination connection and allocation resource, to achieve the desired care quality in a cost-effective way. 3 The mode generally includes four aspects, namely mode type, basic process of case management, implementation and effectiveness evaluation. The implementation process consists of six steps, namely case screening (receiving cases), evaluation, planning, implementation, evaluation and feedback. 4 Case management has been applied to the physiological, psychological and social problems of cancer patients. 4  Familiar with diagnosis and condition, normal mental and memory; Have complete language skills. (D) The informed consent of the patients had been obtained before the study and they were willing to accept the researcher's case management model. A total of 100 patients were included in this study and randomly divided into control group and experimental group according to the table of random digit. To avoid information contamination, patients in the two groups were hospitalized on different floors of the radiotherapy department. Both floors are radiotherapy wards for head and neck tumors, with homogenized management and treatment. There was no statistical difference in the baseline information between the two T A B L E 1 Comparison of general data of nasopharyngeal carcinoma patients between two groups (X ± S; n/%).

| Experimental group
The composition of the reference an research staff There were three tumor nurses, two attending doctors, two medical technicians of radiotherapy center, two nutrition nurses and one psychological consultant. A multidisciplinary team was formed with a total of 10 members, and a special case management team was established. One oncology nurse acted as a case manager and led and carried out the work as a case manager. All staff have more than 5 years of nasopharyngeal cancer radiotherapy working experience and bachelor degree or above, and have good communication, coordination and expression skills, excellent medical and nursing performance is preferred.

Training content and assessment
The concept and purpose, operation mode, key links and application of case management; Nursing problems and intervention methods of nasopharyngeal carcinoma patients with radiotherapy and chemotherapy; Contents and methods of nasopharyngeal carcinoma follow-up.
After the training, the research team will assess the participants' theoretical knowledge and simulated case, and only those who pass the assessment can participate in the study.

The research methods
The whole process of case management is divided into four periods: diagnosis period, before radiotherapy, during radiotherapy, and after discharge after radiotherapy.  10 According to the total score (172 points) and each score, the self-care ability was divided into three levels, in which the score >66% of the total score (113 points) was high level, the score >33% $ 66% of the total score (56 $ 113 points) was medium level, and the score <33% (56 points) was low level.

| Patient satisfaction questionnaire
The Lopss scale translated by Susan et al. was adopted. 11,12 Cronbach's α coefficient is .81. It includes two dimensions, 24 items, namely the nursing interpersonal relationships (14 items), patient satisfaction (10 items), each entry using Likert's level 5 score method, which is not very satisfied, not satisfied, general, happy, very satisfied, give respectively 1, 2, 3, 4, 5 points, the higher the score, that patient satisfaction, the better.

| Statistical methods
SPSS19.0 statistical software was used for statistical analysis. Counting data were described by the number of cases and percentage, and χ 2 test was used for comparison between groups. Measurement data were described as mean ± standard deviation, and two independent sample t-test was used for comparison between groups. p < .05 was considered as statistically significant difference between the two groups.

| RESULTS
Three months after discharge, the average scores of all dimensions and total scores of the experimental group were significantly higher than those of the control group, the proportion of high level patients (90%) was significantly higher than that of the control group (62%), and the proportion of low level patients was lower than that of the control group, with statistical significance (P < .01). The results are shown in Table 3.
Three months after discharge, the scores of nursing interpersonal relationship in the experimental group were higher than those in the control group, and the scores of dissatisfaction were lower than those in the control group, with statistical differences (P < .01). The results are shown in Table 4.
After intervention, the treatment interruption rate of patients in the experimental group who had no temporary radiotherapy due to excessive skin and oral reaction was significantly lower than that of the control group, and the on-time return rate of the experimental group was also significantly higher than that of the control group, with statistical significance (P < .05). The results are shown in Table 5.

| CONCLUSION
Case management is a new management care model that attracts the most attention and is the most widely used in clinical nursing work in the field of chronic diseases and cancer at home and abroad. 5 At present, the effectiveness evaluation of case management in Europe, America and Taiwan is comprehensive, and the results can be promoted in a timely manner. A large number of foreign practices have proved that the case management model has remarkable results. 23 In recent years, domestic case management has also achieved good results in the field of cancer, but due to the late start and lack of systematic and specific management mode, it is still in the initial stage of exploration. [4][5][6] This study explored the application and effect evaluation of case management nursing practice mode in nasopharyngeal carcinoma patients, and the results showed that it significantly improved patients' self-care ability and satisfaction, and expanded the breadth and depth of nasopharyngeal carcinoma specialty nursing.
However, the specific process of case management and investigation and analysis in this study is still not comprehensive. In the future work, we will further improve the nasopharyngeal cancer case management process based on the current research results, in order to better guide the clinical specialist nursing work, in order to provide reference for exploring the suitable tumor patient case management mode in our country.

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

CONFLICT OF INTEREST
All authors of this manuscript have directly participated in planning, execution, and/or analysis of this study.

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