The effect of a modified perioperative management model on the mental state, quality of life, and self-care ability score of patients after radical prostatectomy: A retrospective study

Abstract

To explore the effects of an improved perioperative management model on the mental state, quality of life, and self-care ability scores of patients after radical prostatectomy. Overall, 96 postoperative prostate cancer patients admitted to our hospital between November 2019 and May 2021 were retrospectively analyzed and classified into an observation group and a control group with 48 patients each, according to the management model they received. The patients in the control group received routine care and were discharged. The observation group implemented an improved perioperative management model than the control group. Differences in mental state, quality of life, and self-care ability scores between the 2 groups were compared. After nursing, the self-rating anxiety scale and self-rating depression scale scores of the 2 groups were significantly lower than those before nursing, and the observation group’s self-rating anxiety scale and self-rating depression scale scores were significantly lower than those of the control group (P < .05). Regarding emotion, cognition, and society, the observation group’s quality of life scores was significantly higher than those of the control group. In contrast, overall health was significantly lower than that of the control group (P < .05). After nursing, the observation group’s self-care skills, self-responsibility, health knowledge, and self-concept scores were significantly better than those of the control group (P < .05). The improved prostate cancer perioperative management model helps improve patients’ unhealthy mental state, quality of life, self-care ability, and provides guidelines for the clinical care of patients after prostate cancer surgery.

1. Introduction

As a malignant tumor of the male reproductive system with a high clinical incidence, prostate cancer has risen to the first place among male malignant tumors in European and American countries, and the number of knowledgeable people is second only to lung cancer.^[1] The incidence of prostate cancer in Asian countries is at its lowest; however, recently, the country’s aging process has accelerated, the number of prostate cancer patients has increased significantly, and the incidence of prostate cancer has shown a younger trend.^[2] Prostate cancer is mostly diagnosed in the early and mid-term because of the development of prostate cancer diagnostics and the popularity of MRI, PSA screening, and other testing methods.^[3,4] Currently, laparoscopic radical prostatectomy is mainly used to treat prostate cancer in clinics, and the postoperative recovery of patients is important for clinicians.^[5] According to studies, reasonable perioperative care improves the rehabilitation of patients with laparoscopic prostate cancer.^[6]

The perioperative period is the process surrounding the operation, from the patient’s decision to accept the surgical treatment to the surgical treatment until the basic recovery. It includes the time before, during, and after the operation, specifically from the time when the surgical treatment is determined until the treatment related to this operation ends. This is approximately 5 to 7 days before the operation to 7 to 12 days after the operation.^[7] Traditional perioperative management includes adjustment of preoperative physiological and psychological conditions, intraoperative anesthesia management and surgical techniques, and maintenance of postoperative physiological status.^[8] This definition and management measures guide clinical practice for a long time and are crucial in improving the quality and safety of patients surgery.^[9] Therefore, this study explored the impact of an improved perioperative management model on patients psychological status, quality of life, and self-care ability scores after radical prostate cancer surgery.

2. Materials and methods

2.1. Research object

Ninety-six postoperative prostate cancer patients admitted to our hospital between November 2019 and May 2021 were included in the retrospective analysis and classified into observation and control groups according to the management model they received, with 48 cases in each group. The observation group was 39 to 68 years old, with an average age of 49.26 ± 5.14 years; an average prostate volume of 15.33 ± 6.95 mL; TM staging: 18 cases of T1cN0M0, 15 cases of T2bN0M0, 15 cases of T2cN0M0; education level: 8 cases of junior high school, 22 cases of high school and technical secondary school, 18 cases of junior college and above. The control group was 38 to 70 years old, with an average age of 50.03 ± 5.22 years; an average prostate volume of 15.59 ± 6.98 mL; TM staging: 18 cases of T1cN0M0, 17 cases of T2bN0M0, 14 cases of T2cN0M0; education level: 20 cases of junior high school, 20 cases of high school and technical secondary school, 8 cases of junior college and above. The 2 groups general characteristics were well-balanced, and no statistically significant difference was observed (P > .05). Consent was obtained from all patients. The medical research ethics committee of Second Hospital of the Anhui Medical University approved this study.

2.2. Inclusion and exclusion criteria

Inclusion criteria: The included patients comply with the “consensus on prostate cancer-standardized specimen collection and pathological diagnosis.”^[10] A prostate cancer diagnosis standard, and completed laparoscopic radical prostate cancer surgery in our hospital; the operation process was smooth; The patient took care of herself, used the telephone, had an education level of elementary school or above, and had complete language skills; There was no abnormal function of the heart, lungs, or vital organs, the tumor had no distant metastasis, and the clinical data were complete. The exclusion criteria were as follows: Severe liver and kidney dysfunction, severe inflammation, infection, immune system disease or coagulation dysfunction, lung metastasis, and lymph node metastasis; Low expected 1-year survival rate and prognosis in worse cases, with prostate cancer being the metastasis of other malignant tumors rather than primary cancer; and Mental disorders.

2.3. Intervention methods

The control group received routine nursing and discharge guidance as follows. After admission, patients received regular education about prostate cancer, including treatment methods, nursing procedures and methods, and health knowledge. Before the surgery, the patient was required to prepare the bowel. The day before the operation, at 3 PM and 9 PM, 25 mL of lactulose should be taken in each, followed by 1000 mL of warm water. The preparation can also be compared to the patient’s specific situation. In the first 3 hours, 200 mg of celecoxib was administered for oral analgesia, and the corresponding precautions were explained to the patient. The night before surgery, the patients had to fast for 6 hours before surgery, drink water for 3 to 4 hours, and drink 200 mL of 10% glucose liquid for 2 hours before going to bed (drinks for diabetic patients). Drink 400 mL of sugar-salt liquid (warm water or pulsation) 3 to 4 hours before the operation. Simultaneously, the patient’s sleep status should be observed, diet and sleep regularity should be checked, the patient should be evaluated for anesthesia, and preoperative skin cleaning should be performed. The postoperative diet should be light, moisten the mouth, promote food digestion and absorption, take care of the patient early, get out of bed, perform limb stretching exercises, and avoid pressure sores. Inform patients and family members about the most frequent complications of this type of disease and the corresponding treatment methods. Inform the patient and family members about how to deal with the negative emotions caused by the illness during hospitalization. Strictly follows the doctor’s advice and provide the patient with appropriate daily care. If the patient’s condition fluctuated, the physician in charge was contacted to assist with treatment.

The observation group implemented an improved perioperative management model based on the control group, namely: Before the operation: Evaluate the patient’s psychological condition, relieve the anxiety of the patient, and explain to the patient about the pain, bleeding, and other problems that may occur after the operation; the corresponding precautions to the patient, obtain the patient’s cooperation, relieve the patient’s emotions, ask about the patient’s feelings, respect the patient’s psychological wishes, provide comprehensive surgical education to the patient, and prepare the patient for various treatments during the perioperative period. Advocacy preparations can be appropriately canceled to reduce the patients’ fear. Patients should be guided to perform chest expansion exercises, deep breathing training, balloon blowing exercises, etc, 3 days before surgery and should be guided to rehabilitate the levator ani muscles 2 days before surgery. To relieve patients’ anxiety the day before surgery, communicate cordially with the patient, and guide the patient to perform leg venous thrombosis marching. It is necessary to avoid asking patients to fast and drink water too early to avoid postoperative insulin resistance. Determine the type of anesthesia based on the patient’s situation for increased blood sugar, and ensure that the patient’s questions during the operation is not lower than 36°C; when giving an intravenous infusion of more than 500 mL of liquid, it should be heated to 34 to 37°C; After the operation, if the patient is unsuitable for eating, the mouth can be moistened with warm water. If there is a bowel sound on auscultation 6 hours after the operation, the patient can be provided with 200 mL of sugar and saline for 4 to 6 hours per session. Observation of the patient’s condition is necessary. Gradually increase the type of diet to keep the stool smooth. The diet should help digestion, assess the patient’s pain, relieve pain early, encourage the patient to exercise, and prevent venous thrombosis formation. Raise the head of the bed by 10°C and after 6 hours to 30°C, turn over 2 hours/time, raise the hips 5 to 10 times/group, 2 to 4 groups/day, and perform ankle pump exercise for 5 minutes/2 hours. On the first post-surgery day, 1 can observe the patient’s condition, help the patient stroll at the bedside, and gradually move with the aid of a walker. Depending on the situation, the patient should exercise for more than 15 minutes daily for a short time if the limbs feel numb and stiff or take a massage or exercise in bed to soothe them. Excessive fluid replacement should be avoided to reduce the burden on the heart and lungs, attention should be paid to the amount of fluid infusion, the stability of the infusion tube, and the drainage volume and nature of the drainage fluid. If a patient develops urinary incontinence, levator exercises should be performed.

2.4. Observation indicators

2.4.1. Psychological state

Patients anxiety levels were evaluated using the self-rating anxiety scale (SAS), with a full score of 100. The higher the score, the more severe the patient’s anxiety. The patient’s depression level was evaluated using the self-rating depression scale (SDS), with a maximum score of 100. The higher the score, the more severe the patient’s depression. Both groups were evaluated for indicators before and 3 months after discharge. The Cronbach α values measured before use were all >0.914.

2.4.2. Quality of life

The patient will be followed up by telephone after 3 months of treatment. They will be evaluated for quality of life using the core scale for cancer patients. There are 30 items. According to the patient’s answer options, from 1 to 7 points, other items are classified into 4 levels: nothing to a little, more than 4 points, and 1 to 4 points directly, usually classified into several categories. There were 15 domains, categorized into 4 functional domains: physical, cognitive, emotional, and social functions; 3 symptom domains such as fatigue, pain, nausea, and vomiting; 1 overall health status/quality of life domain, and six individual domains (each as a domain). The scores of the items in each domain were added and divided by the number of items in the domain to obtain the score for the domain. The significance of the scoring rules: the higher the score for function and overall health, the better the function and quality of life; the higher the score for symptoms, the more the patient’s symptoms of discomfort, and the worse the quality of life. The Cronbach α values measured before use were all >0.914. Patients or their accompanying family members completed the test independently before treatment and 3 months after treatment without being affected by any internal or external factors. The test was completed in 57 minutes.

2.4.3. Self-care ability score

The self-care ability scores of the 2 groups of patients were compared using the self-care ability measurement scale to evaluate before and 3 months after the intervention. This included 4 items of self-care skills, health knowledge, self-concept, and self-responsibility. The scale has 43 items, each scoring 0 to 4 points, with a total score of 172 points; the higher the score, the stronger the patient’s self-care ability.

2.5. Statistical methods

Statistical analysis was performed using the SPSS 25.0 software. Continuous data are expressed as mean ± standard deviation and compared using the t test. Categorical data are expressed as n (%) and compared using the chi-square test. P < .05 indicated that the difference was statistically significant.

3. Results

3.1. Comparison of mental states

Before nursing, no significant differences were observed in the SAS and SDS scores between the 2 groups of patients (P > .05). After nursing, the 2 groups SAS and SDS scores were lower than those before nursing, and the observation group’s SAS and SDS scores were lower than those of the control group. Group (P < .05) (Table 1).

Table 1.

Comparison of mental status scores between the 2 groups.

Group	SAS score	SDS score
Before care
Observation group (n = 48)	56.39 ± 4.75	62.23 ± 5.08
Control group (n = 48)	56.42 ± 4.79	62.25 ± 5.07
t	−0.031	0.019
P value	.975	.985
After care
Observation group (n = 48)	32.64 ± 3.31a	34.49 ± 3.74a
Control group (n = 48)	45.68 ± 3.47a	48.89 ± 3.66a
t	−18.839	−19.065
P value	.003	<.001

A represented compared with before nursing, P < .05.

SAS = self-rating anxiety scale, SDS = self-rating depression scale.

3.2. Comparison of quality-of-life scores

The observation group’s quality of life scores, such as emotion, cognition, society, and overall health, were significantly higher than those in the control group, while the physical, fatigue, nausea, vomiting, and pain scores were lower than those of the control group, which was statistically significant (P < .05) (Tables 2 and 3).

Table 2.

Comparison of the quality of life (mental) of the 2 groups of patients.

Group	Body	Cognition	Emotions	Society
Control group (48)	77.27 ± 10.14	59.27 ± 16.23	62.21 ± 10.21	50.14 ± 10.16
Observation group (48)	70.23 ± 11.57	66.25 ± 16.82	70.23 ± 10.57	55.15 ± 12.45
t	3.17	−2.069	−3.781	−2.16
P value	.002	.041	<.001	.033

Table 3.

Comparison of the quality of life (symptoms) of the 2 groups of patients.

Group	Overall health	Feel sick and vomit	Tired	Pain
Control group (48)	50.27 ± 10.14	52.27 ± 8.23	54.18 ± 11.68	42.14 ± 5.21
Observation group (48)	59.23 ± 10.57	48.25 ± 8.82	46.23 ± 10.57	34.15 ± 5.64
t	−4.238	2.819	3.496	7.21
P value	<.001	.006	.001	<.001

3.3. Comparison of self-care ability scores

The comparison of the self-care ability scores of the 2 groups before nursing was not statistically significant (P > .05). After nursing, the observation group’s self-care skills, self-responsibility, health knowledge, and self-concept scores were better than those of the control group (P < .05) (Table 4).

Table 4.

Comparison of the self-care ability scores of the 2 groups of patients.

Group	Self-care skills	Self-responsibility	Health knowledge	Self-concept
Before care
Observation group (n = 48)	33.56 ± 5.18	17.97 ± 4.43	40.87 ± 8.71	19.58 ± 5.44
Control group (n = 48)	33.58 ± 4.21	18.95 ± 3.42	41.92 ± 7.73	18.61 ± 4.42
t	−0.021	−1.213	−0.625	0.939
P value	0.983	0.228	0.543	0.35
After care
Observation group (n = 48)	46.79 ± 6.82a	29.29 ± 6.06a	27.17 ± 8.43a	28.94 ± 7.02a
Control group (n = 48)	38.12 ± 8.43a	21.87 ± 5.12a	21.16 ± 7.42a	23.21 ± 6.96a
t	5.54	6.48	3.708	4.016
P value	.002	<.001	.013	.029

A represented compared with before nursing, P < .05.

4. Discussion

Perioperative management encompasses the entire life cycle of patient surgery, diagnosis, and treatment. It realizes information management of medical process management, quality control, message reception and push, statistics, and analysis of reports, and promotes the optimal allocation of operating room resources and maximum use efficiency. It is reasonable to arrange patient perioperative medical treatment, nursing, medication, rehabilitation, and other process monitoring to improve the quality of hospital operations and the level of medical services.^[11] Perioperative management can provide patients with continuous and high-quality nursing services, maximizing the benefits of both, strengthening the clinical nursing effect, and allowing patients to obtain high-quality nursing services while at home.^[12]

In this study, the SAS and SDS scores of the 2 patient groups after nursing were lower than those before nursing, and the observation group’s SAS and SDS scores were lower than those of the control group after nursing. This may be because of the emphasis on psychological intervention during improved perioperative management and the explanation of postoperative considerations during the psychological intervention process, which improves the correct understanding of postoperative prostate cancer and encourages family members communication and then can feel cared for by family.^[13] After thoroughly assessing the patient’s and family members psychological problems, the responsible nurse adopted personalized psychological counseling based on the individual characteristics and needs of the patient and family members, such as explaining successful cases to increase the patient’s confidence in the disease’s treatment.^[14] Middle-aged patients with high risk prostate cancer experience hearing or vision loss, memory loss, loss of comprehension and expression, and other aging problems. You can use gestures, talk near the patient’s ear, or provide hearing aid, use picture albums, provide magnifying glasses, and other detailed services to explain the disease to patients and their families. The basic knowledge of perioperative treatment, prognosis, surgery-related recovery needs, and timely assessment of the mastery of patients and their families.^[15]

This research was based on many years of our experience working in the department. Based on routine care of patients, various details of care have been strengthened to form a comprehensive intervention per the perioperative management of patients undergoing radical prostatectomy. Strengthening bedside patrols based on routine ward rounds and nursing care can capture subtle patient changes. These changes are beyond the requirements of nursing operations, but minor changes often imply changes in conditions. Early detection is conducive to early treatment and can improve the effectiveness of patient treatment.^[16] These patients often presented with multiple diseases. The increased number of nursing staff inspections reflects the nursing staff’s care for patients. Although they guide the patient’s diet during hospitalization, the observation group receiving guidance is more detailed and has practical significance.^[17] Patients can receive good dietary and nutritional guidance during hospitalization and adjust their diet after discharge according to the relevant knowledge taught by nursing staff, which promotes subsequent physical recovery.^[18] Psychological problems have always been a serious problem in hospitalized patients, especially seriously ill cancer patients, during hospitalization.^[19] Elderly patients are mainly affected; they suffer from poor physical conditions, and the disease is highly malignant. In particular, the medical and surgical costs faced by patients and their families are relatively high. However, because of the complexity and long-term nature of the disease, sexuality requires long-term support and care from family members, and patients often experience greater psychological pressure.^[20] Studies have shown that such patients bear greater financial and emotional burdens, and subjective negative feelings such as guilt and worry are high. The patient’s self-care ability is very poor, coupled with the inner feeling of loneliness, a sense of dependence that is eager for help, anxiousness about the future, and a feeling of despair, which makes the psychological burden very heavy.^[21] This burden leads to poor mood and directly affects the treatment’s effect. In this study, several methods were used to guide and solve the patients’ psychological problems, reduce the patients anxiety and reactions to depression, guide them to think more positively about the problem, understand themselves and their diseases, and realize that they have already done so. These measures will enable us to effectively use our strengths, advantages, and capabilities.^[22] When a patient’s mood improves, the degree of autonomic nerve activity, heart rate, blood pressure, and the risk of disease deterioration caused by emotional reactions decreases.^[23] Nosocomial infections are also a problem that must be faced by severely ill hospitalized patients for a long time, especially cancer patients undergoing surgical treatment, are feeble and have a high risk of infection. This study focused on this issue and adopted a simpler and more practical method for preventing infection and providing patient care. This method is crucial in alleviating the patient’s condition, reducing medical expenses, and shortening hospital stays. This study also emphasized that the nursing staff should urge patients to exercise daily. One of the main causes of prostate disease is the lack of exercise.^[24] Therefore, it is necessary to keep the patient within the allowable range and perform certain exercises that positively influence the recovery of the disease or the maintenance of health in the future.

Improvement and renewal of perioperative management have also improved surgery quality and rehabilitation. With a deeper understanding of the perioperative period, it is necessary to broaden the definition of the perioperative period and extend its end node to include the resumption of daily work. In the evaluation of perioperative management, based on surgical quality and rehabilitation efficiency, the treatment cost is increased, and corresponding reference indicators are set simultaneously to comprehensively and uniformly evaluate the rationality and feasibility of perioperative management measures. Whether it is quality, efficiency, or cost, the experience of the entire perioperative period is ultimately for the patient; that is, whether the operation is good enough, the recovery is fast enough, and the process is affordable enough. Improving perioperative experience should be further researched and promoted as a new concept in perioperative management.

Although this study achieved the expected research purpose, it has some limitations. First, postoperative rehabilitation of patients is influenced by many subjective and objective factors beyond just care-related factors. Given the need to eliminate the impact of these factors on the experiment, a related factors analysis was performed on the preliminary investigation of all subjects to select independent, objective, and relatively highly stable factors for our research; Second, since the 2 groups were randomized grouping, ensuring that there was no statistically significant difference in the baseline data between 2 groups was difficult. Therefore, we included the other sample size calculation process and selected a more appropriate sample process during practical research. We also adopted the propensity score method to match baseline data between the 2 groups, ensuring that the 2 data sets were as comparable as possible.

This study provided a reliable experience for the care of patients discharged after radical prostatectomy at our hospital. Considerably, it also promoted improvements in the quality of care in our department. Similarly, this study has some deficiencies because of the limitation of the number of cases. The sample size of this study is small, and because of the influence factors, such as age and education level, most patients were elderly individuals in rural areas, which resulted in relatively few samples. Another shortcoming of this study is the short intervention time, and the continuity of nursing measures which need to be further improved. In the future, it is necessary to strengthen the promotion of online platforms, expand the sample size, and extend the intervention time. In summary, the improved perioperative management model for prostate cancer is beneficial for improving patients unhealthy mental states, enhancing their quality of life and self-care ability, and providing a reference for the clinical care of patients after prostate cancer surgery.

Author contributions

Conceptualization: Miao Zhang, Jianxia Jia.

Data curation: Xianwen Hu, Jianxia Jia.

Formal analysis: Miao Zhang, Jianxia Jia.

Funding acquisition: Xianwen Hu.

Investigation: Miao Zhang.

Methodology: Xianwen Hu.

Project administration: Miao Zhang, Dequan Wu.

Resources: Xianwen Hu, Dequan Wu.

Software: Miao Zhang, Dequan Wu.

Supervision: Xianwen Hu, Dequan Wu.

Validation: Miao Zhang, Dequan Wu.

Visualization: Xianwen Hu, Dequan Wu.

Writing – original draft: Dequan Wu.

Writing – review & editing: Dequan Wu.