基于Cox客户健康行为互动模型的出院准备方案对喉癌手术患者的影响

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中文摘要

背景： 出院准备度对康复结局至关重要，但传统出院教育往往无法满足喉癌手术后的个体化需求。Cox客户健康行为互动模型（IMCHB）提供了一个以患者为中心、强调互动与赋能的框架，但其在该人群中的应用鲜有报道。本研究评估了基于IMCHB的出院准备干预在喉癌手术患者中的效果。
材料与方法： 这项准实验、非随机对照研究采用便利抽样，在某三级医院招募接受喉癌手术的患者。按入院顺序分配65例患者（干预组33例，对照组32例）。对照组接受常规护理；干预组接受基于IMCHB的出院准备干预加常规护理。在干预前、出院时和出院后1个月比较两组的出院准备度、自我管理能力及焦虑/抑郁。对关键组间比较计算效应量和95% CI。
结果： 出院时，干预组出院准备度评分更高（99.97±6.31 vs 88.09±6.14；MD=11.88，95% CI：8.65-14.71；Cohen's d=1.91），自我管理能力更高（174.73±9.35 vs 152.13±12.78；MD=22.60，95% CI：17.05-28.15；Cohen's d=2.02），焦虑评分更低（41.48±2.89 vs 43.19±3.70；MD=-1.71，95% CI：-3.36至-0.06；Cohen's d=0.51）。出院后1个月，自我管理能力仍更高（189.00 [186.00, 191.50] vs 144.00 [133.00, 154.50]；Mann-Whitney r=0.86），抑郁评分更低（40.73±3.18 vs 46.75±3.09；MD=-6.02，95% CI：-7.57至-4.47；Cohen's d=1.92）。
结论： 基于IMCHB的出院准备与喉癌手术后更高的出院准备度和自我管理能力以及更低的焦虑/抑郁评分相关。这些发现应谨慎解读，需要随机对照试验来确认其有效性和临床实用性。

英文摘要

BACKGROUND Readiness for hospital discharge is critical for rehabilitation outcomes, yet traditional discharge education often fails to meet individualized needs after laryngeal cancer surgery. The Cox Interaction Model of Client Health Behavior (IMCHB) provides a patient-centered framework emphasizing interaction and empowerment, but its application in this population is rarely reported. IMCHB-based discharge preparation intervention in patients undergoing laryngeal cancer surgery was evaluated. MATERIAL AND METHODS This quasi-experimental, non-randomized controlled study used convenience sampling to recruit patients undergoing laryngeal cancer surgery at a tertiary hospital. Sixty-five patients (33 intervention, 32 control) were assigned by admission order. The control group received routine nursing care; the intervention group received an IMCHB-based discharge preparation intervention plus routine care. Groups were compared for readiness for hospital discharge, self-management ability, and anxiety/depression before the intervention, at discharge, and 1 month after discharge. Effect sizes and 95% CIs were calculated for key between-group comparisons. RESULTS At discharge, the intervention group had higher readiness-for-discharge scores (99.97±6.31 vs 88.09±6.14; MD=11.88, 95% CI: 8.65-14.71; Cohen's d=1.91), higher self-management ability (174.73±9.35 vs 152.13±12.78; MD=22.60, 95% CI: 17.05-28.15; Cohen's d=2.02), and lower anxiety scores (41.48±2.89 vs 43.19±3.70; MD=-1.71, 95% CI: -3.36 to -0.06; Cohen's d=0.51). One month after discharge, self-management remained higher (189.00 [186.00, 191.50] vs 144.00 [133.00, 154.50]; Mann-Whitney r=0.86), and depression scores were lower (40.73±3.18 vs 46.75±3.09; MD=-6.02, 95% CI: -7.57 to -4.47; Cohen's d=1.92). CONCLUSIONS IMCHB-based discharge preparation was associated with higher readiness for discharge and self-management ability and lower anxiety/depression scores after laryngeal cancer surgery. These findings should be interpreted cautiously, and randomized controlled trials are needed to confirm its effectiveness and clinical utility.