认知性访谈在乳腺癌相关淋巴水肿患者支持性照护需求量表编制中的应用  

Application of cognitive interviewing in the development of a supportive nursing needs scale for patients with breast cancer related lymphedema

作　　者：张丽媛 卞静如 沈傲梅 强万敏 武佩佩 王言言 ZHANG Liyuan;BIAN Jingru;SHEN Aomei;QIANG Wanmin;WU Peipei;WANG Yanyan(Tianjin Medical University Cancer Institute and Hospital/National Clinical Research Center for Cancer/Tianjin Clinical Research Center for Cancer/Key Laboratory of Breast Cancer Prevention and Therapy,Tianjin Medical University,Ministry of Education,Key Laboratory of Cancer Prevention and Therapy,Tianjin 300060,China;Peking University Nursing College Internal and Ecternal Science and Education Reseaech Room,Beijing 100191,China)

机构地区：[1]天津医科大学肿瘤医院,国家恶性肿瘤临床医学研究中心,天津市恶性肿瘤临床医学研究中心,乳腺癌防治教育部重点实验室,天津市“肿瘤防治”重点实验室,天津300060 [2]北京大学护理学院内外科教研室,北京100191

出　　处：《护理实践与研究》2024年第12期1786-1793,共8页Nursing Practice and Research

基　　金：天津市卫生健康委员会医学重点学科(专科)建设项目(编号:TJYXZDXK-011A)。

摘　　要：目的应用认知性访谈对乳腺癌相关淋巴水肿患者支持性照护需求量表进行修改,优化条目表达,进一步提高量表在目标人群中的可理解性和适用性,提升后续调查结果准确性。方法在支持性照护需求理论的框架指导下,通过文献回顾、专家函询形成初测量表。选取2023年6—7月就诊于天津某三级甲等肿瘤专科医院淋巴水肿护理咨询门诊的22名乳腺癌相关淋巴水肿患者作为研究对象,进行三轮认知性访谈,使用内容分析法结合QAS-99编码系统对访谈资料进行编码归类和分析,并依据每轮访谈结果,经专家小组讨论在不改变原义的情况下对量表条目进行修订。结果第1轮完成12例认知性访谈,第2轮完成5例认知性访谈,访谈资料分析出问题大多聚类于条目“清晰问题”,受访者的释义与研究者本义略有偏差,根据具体子类别进行修改,第1轮5个条目予以修改,第2轮1个条目予以修改。第3轮完成5例认知性访谈,受访者能够正确理解条目,研究者与受访者释义一致,达到信息饱和。结论通过认知性访谈,了解乳腺癌相关淋巴水肿患者支持性照护需求量表在目标人群中的理解情况和认知偏差,识别此次量表编制的条目模糊问题和应答困难问题,并以此为依据有效地指导条目修订,提高了量表科学性和准确性。Objective To modify the Supportive Care Needs Scale for patients with breast cancer-related lymphedema using the cognitive interview to optimize the expression and improve the quality of the scale.Methods According to the conceptual framework of supportive care needs,the preliminary scale was developed by literature review and expert consultations.22 patients with breast cancer-related lymphedema were selected as interviewees from June to July of 2023 from ClassⅢGrade A hospital in Tianjin to attend three rounds of cognitive interviews.The interview Sample were coded and analysed using the Question Appraisal System(QAS-99)combining content analysis,then the items of the scale were revised according to the results of the interviews and the group discussions.Results In the first round,12 cognitive interviews were completed,and 5 cognitive interviews were completed in the second round.Most of the questions collected in the interview data were clustered in the items"clarity-bias in the understanding of the items between the developer and the target population during scale development",which were modified according to the specific sub-category,5 items in the first round were modified and 1 items in the second round were modified.Five cognitive interviews were completed in the third round and reached data saturation,the interviewees were able to understand all the items.Conclusion Through the cognitive interview,we understood the cognitive bias of the Supportive Care Needs Scale for patients with breast cancer-related lymphedema in the target population,identified the problems of item ambiguity and response difficulties in the scale,and the method effectively guided the item revision,thus improved the scientificity and accuracy of the scale.

关 键 词：乳腺癌相关淋巴水肿 支持性照护需求 认知性访谈 量表编制 理解偏差 

分 类 号：R47[医药卫生—护理学]