Effect of gastrointestinal endoscopy center care on the psychological state and pain level of colorectal cancer patients

Abstract

BACKGROUND

Colorectal cancer (CRC) has become the third leading cancer with the third highest occurrence rate and the second highest death ratio globally. Its incidence and mortality rates have been increasing annually in recent years, posing a serious threat to global public health. Digestive endoscopy technology can not only be used for the diagnosis of CRC, but it can also be used in determining the depth of infiltration in early CRC. There are significant deficiencies in care measures in this area.

AIM

To investigate the effect of digestive endoscopy center nursing on the psychological state and pain level of CRC patients.

METHODS

A total of 120 CRC patients were randomly and equally divided into a control group and an observation group. The patients in the control group received basic routine nursing care, and the patients in the observation group received systematic digestive endoscopy center nursing care. The patients' compliance and nursing satisfaction were observed and recorded, as well as the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and Visual Analogue Scale (VAS) scores.

RESULTS

After care, the SAS and SDS scale scores of patients in both groups significantly decreased compared to before care (P < 0.05). The VAS scale scores significantly increased for each group compared to before examination (P < 0.05). The SAS, SDS and VAS scale scores of the observation group were significantly lower than those of the control group after nursing care (P < 0.05), and compliance and satisfaction of nursing care were significantly higher than those of the control group (P < 0.05).

CONCLUSION

Digestive endoscopy center nursing can effectively intervene in and improve the psychological state and pain level of CRC patients, suggesting it is a valuable approach to adopt in the clinic.

Key Words: Gastrointestinal endoscopy center care; Psychological state; Pain level; Colorectal cancer; Patients; Care

Core Tip: This study explores the impact of gastrointestinal endoscopy center nursing on colorectal cancer (CRC) patients. It finds that systematic nursing care significantly reduced anxiety (Self-Rating Anxiety Scale), depression (Self-Rating Depression Scale), and pain levels (Visual Analogue Scale), while enhancing patient compliance and satisfaction. This highlights the crucial role of specialized nursing interventions in improving the psychological and physical well-being for CRC patients undergoing endoscopic procedures.

INTRODUCTION

Colorectal cancer (CRC) has become the third leading cancer with the third highest occurrence rate and the second highest death ratio globally. Its incidence and mortality rates have been increasing annually in recent years, posing a serious threat to global public health[1,2]. According to global statistics, the high occurrence of CRC is primarily concentrated in developed countries, but with lifestyle changes, the occurrences and death ratios associated with CRC are also gradually increasing in developing countries, especially in China, where the incidence and death ratio associated with CRC have continued to increase in recent years. Therefore, it has become an important problem threatening the health of residents in China[3-5]. Early diagnosis and treatment are significant for improving prognosis. As medical technology advances, noninvasive examination via gastrointestinal endoscopy plays a significant role in the early screening and treatment of CRC. Digestive endoscopic mucosal resection is now commonly used to treat patients with early CRC and precancerous lesions, which can effectively resect the lesions, avoid the trauma of open surgery, and reduce the patient's recovery time and complication risk[6,7]. Digestive endoscopic submucosal dissection is a more advanced treatment modality, especially for larger lesions or colorectal lesions that are hard to resect, which can more accurately resect the lesions and preserve maximal organ function with better prognosis[8,9]. In addition, digestive endoscopy technology can not only be used for CRC diagnosis, but it can also be used to determine the depth of infiltration of early CRC[10]. Although digestive endoscopy techniques have made significant progress in early diagnosis and treatment, patients often feel discomfort and anxiety when undergoing such examinations. Many patients are unfamiliar with the endoscopic procedure and may be psychologically fearful of pain or complications. There are significant deficiencies in care measures in this area. In fact, pain and discomfort are important factors affecting patient compliance and quality of operation, which may lead to patients' refusal or delay in receiving treatment due to fear of pain, subsequently affecting timely detection and treatment of disease[11-15]. Therefore, gastrointestinal endoscopy center nursing is crucial for the intervention of CRC patients. Nursing interventions can reduce patients' anxiety and pain perception by providing detailed pre-examination explanations, emotional relief, analgesia and anesthesia management, and other aspects of support. Effective nursing interventions can not only enhance patient compliance but also improve surgical outcomes and post-examination recovery. For example, with reasonable analgesic measures, psychological support and appropriate post-examination care, post-examination discomfort can be significantly reduced, and the overall effect of treatment and quality of life of patients can be enhanced. In conclusion, with the rising incidence of CRC, the use of digestive endoscopy techniques for early diagnosis and treatment has become increasingly more important. Nursing intervention plays an important role in improving patient compliance, reducing discomfort during and after the examination, and enhancing treatment effects. Consequently, there is considerable clinical value to deeply explore and optimize the intervention effect of gastrointestinal endoscopy center nursing on CRC patients.

MATERIALS AND METHODS

General information

One hundred and twenty patients who were examined in our endoscopy center were selected for the study. The patients were randomly assigned to two groups of 60 cases each using a computer-generated random number sequence. There were no statistically significant differences in the general data between the two groups (P > 0.05).

Inclusion criteria: Confirmed diagnosis of CRC; basic literacy and cognitive ability; signed informed consent.

Exclusion criteria: Accompanied by serious organic disorders; not meeting the criteria for digestive endoscopy; people with cognitive and consciousness disorders; accompanied by psychiatric diseases (Table 1).

Table 1 General demographic data of patients in each group, n (%)/mean ± SD.

Group	Number of cases	Sex		Age (years)	Disease duration (years)	BMI	Comorbidities
		Women	Men				Yes	No
Control group	60	28 (46.67)	32 (53.33)	71.83 ± 2.52	5.87 ± 1.55	24.00 ± 4.08	27 (45.00)	33 (55.00)
Observation Group	60	25 (41.67)	35 (58.33)	73.67 ± 2.43	5.68 ± 1.94	24.15 ± 4.00	24 (40.00)	36 (60.00)
t/χ²		0.304		-4.060	0.572	0.569	0.307
P value		0.581		0.529	0.081	-0.203	0.580

BMI: Body mass index.

Methodology

The control group received routine nursing care. Prior to the examination, the basic precautions of the examination were explained to the patient to ensure that he/she understood the relevant process. During the examination, the patient's response was closely monitored, and assistance was provided in completing the examination. These routine care steps ensured that patients receive appropriate care and support during the examination. The observation group received gastrointestinal endoscopy center care as follows. (1)A team was formed, and a process was developed. The nursing team was composed of nurses with rich experience and professional knowledge to ensure teamwork and professionalism. Combined with medical literature and the actual situation of the hospital endoscopy center, a detailed nursing operation process and standards were formulated to cover all aspects. Before the examination, the examination process was fully explained to the patient, including necessary preoperative preparations, such as fasting and medication adjustment. During the examination, nursing staff concentrated on the patient's comfort and psychological state and provided analgesic and sedative support. After the examination, nursing staff increased patient monitoring, observed vital signs, prevented complications, and provided guidance for recovery after the examination. Through this series of standardized nursing operation procedures, patient compliance can be improved, the quality of the examination can be ensured, and the occurrence of complications can be significantly decreased; (2) Training was organized to improve skills. With regular training, nursing staff can deeply understand and master the standard operations in the nursing program and improve their professional skills. The training covered nursing theoretical knowledge, standardized requirements of operation procedures, patient communication skills and emergency handling. In addition, regular nursing skills assessment and simulation exercises can effectively test the practical operation ability of nursing staff and simulate possible emergencies so that nursing staff can gain experience in real scenarios and improve their ability to cope with emergencies. Every week, the nursing team leader is required to evaluate the quality of nursing care, focusing on error-prone links and potential safety hazards, discovering and correcting problems in a timely manner, and formulating practical improvement measures. Through team discussion and feedback, the nursing process and operation standard continuously improved; (3) Quality control and process optimization. To optimize the digestive endoscopy nursing process, it was crucial to strictly control the quality of each nursing link to ensure that each operation complied with the rules and regulations of the hospital and health requirements. Before the examination, standards for patient preparation were ensured, and disinfection and sterilization measures were in place; during examination, nursing staff strictly followed aseptic operating procedures to avoid cross infection. During the endoscopic cleaning and disinfection process, scientific disinfection procedures were used and strict cleaning verification was performed to prevent endoscopic infections. Regular inspection and maintenance of endoscopic equipment was performed to ensure functionality; (4) Environmental care. To guarantee the safety and comfort of patients during gastrointestinal endoscopy, temperature and humidity regulation of the environment was crucial. The indoor temperature was maintained between 23°C and 25°C, and the humidity was maintained within 50% to 60% to ensure a comfortable and appropriate examination environment. At the same time, air circulation was ensured in the room, with regular ventilation on a daily basis. Ultraviolet light was used to sterilize the air to reduce airborne germs and microbial contamination. All examination tools were strictly cleaned and sterilized after each use to ensure aseptic operation and avoid cross-infection. The examination room was fully cleaned and disinfected on a regular basis to ensure that every detail met the hygiene requirements. By carefully regulating the environment and strictly implementing the principle of aseptic operation, a safe, hygienic and comfortable examination environment was provided to safeguard the health of patients and the well-organized progression of the examination process; (5) Psychological care. Before endoscopy, nurses fully communicated with patients, informing them in detail about the precautions for the examination, including preoperative fasting, medication adjustment and other requirements, and explaining possible uncomfortable symptoms, such as abdominal distension, nausea, or mild discomfort, in order to help patients prepare psychologically. Through clear explanations, patients' tension and anxiety could be relieved, unnecessary fears and doubts could be reduced, and patients' cooperation could be improved. To enhance the patient's trust and willingness to cooperate, the nurse could also share positive cases, explaining the safety and reliability of endoscopy, demonstrating the professionalism and safety assurance of the examination process, and enhancing the patient's confidence. By learning about the successful experiences of others, patients tended to more actively participate in the examination process. During the examination, nurses interacted with patients through gentle language, soothing expressions, and body language to help them relax. Through constant encouragement and support, the patient's compliance can be enhanced, and operational difficulties caused by nervousness can be reduced to ensure that the examination is carried out smoothly. At the same time, the nurse can adjust approach according to the patient's response to further reduce their psychological pressure. Through these methods, the patient's comfort and the smoothness of the examination can be effectively improved, providing a more friendly and safe examination experience for the patient; and (6) Discomfort symptoms and post-examination care. Nursing care of discomfort symptoms: If the patient has nausea and vomiting, the nurse should clean up the secretions and vomit in the mouth and nose in a timely manner and provide reassurance to help the patient relax. If the patient suffers from abdominal pain, the possible causes of abdominal pain were explained to the patient and appropriate relief methods were provided. Post-examination care: After the examination, the patient was assisted in getting dressed and arranging for someone to accompany him/her to the convalescent ward, ensuring professional care within 3 hours after the examination to prevent accidents. Through continuous nursing interventions, patients' anxiety and depression can be relieved, post-examination complications reduced, promoting recovery. The following post-examination activities were recommended: Patients were instructed to take moderate walks and abdominal massages, and to start gradually drinking water 2 hours after the examination a to help gastrointestinal recovery. These measures reduced patients' discomfort, improved the quality of care, and promoted recovery after examination.

Observation indicators

Psychological state: The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were applied to assess the psychological state of each patient. The SAS scale had 20 items, each item was ranked into four levels, and Cronbach's α coefficient was 0.796; the SDS scale had 20 items, each item was ranked into four levels, and the Cronbach's α coefficient was 0.785[16].

Compliance: Patients' compliance with the examination was observed and recorded, which was categorized into full compliance, partial compliance and non-compliance.

Pain level: The Visual Analog Scale (VAS) was conducted to measure the pain level. The total possible score was 100 points, with higher scores indicating higher pain level.

Nursing satisfaction: Patients' satisfaction with nursing care was observed and recorded, and was categorized as very satisfied, more satisfied and dissatisfied.

Statistical analysis

SPSS 22.0 software was used to perform data analysis. Quantitative data consistent with normal distribution were presented in the form of (mean ± SD), intergroup comparisons were conducted by independent samples t-tests, and intragroup comparisons were conducted by paired samples t-tests. Qualitative data were presented in the form of [n (%)], and intergroup comparisons were performed by the χ² test. P < 0.05 indicated statistical significance.

RESULTS

SAS scale score comparison

Before care, the difference in SAS scale scores was not significant between the two groups (P > 0.05). After care, the SAS scale scores significantly decreased for both groups (P < 0.05). Compared to the control group, the SAS scale scores of the observation group were significantly lower (P < 0.05) (Table 2).

Table 2 Comparison of Self-Rating Anxiety Scale scores between groups, mean ± SD.

Group	Number of cases	Before care	After care	t value	P value
Control group	60	58.83 ± 2.55	48.85 ± 2.53	19.767	0.000
Observation group	60	59.77 ± 2.42	38.45 ± 2.53	48.041	0.000
t value		-2.051	22.497
P value		0.761	0.006

SDS scale score comparison

Before care, the difference in SDS scale scores was not significant between the two groups (P > 0.05). After care, the SDS scale scores significantly decreased for both groups (P < 0.05). Compared to the control group, the SDS scale scores of the observation group were significantly lower (P < 0.05) (Table 3).

Table 3 Comparison of Self-Rating Depression Scale scores between groups, mean ± SD.

Group	Number of cases	Before care	After care	t value	P value
Control group	60	56.42 ± 2.62	48.77 ± 2.63	16.056	0.000
Observation group	60	56.37 ± 2.44	38.48 ± 2.41	41.664	0.000
t value		0.108	22.345
P value		0.433	0.028

Patient compliance comparison

Compliance was significantly higher in the observation group compared to the control group (P < 0.05) (Table 4).

Table 4 Comparison of patient adherence between groups, n (%).

Group	Number of cases	Full attachment	Partial attachment	Non-attachment	Total attachment
Control group	60	17 (28.33)	24 (40.00)	19 (31.67)	42 (68.33)
Observation group	60	32 (53.33)	22 (36.67)	6 (10.00)	54 (90.00)
χ²					11.439
P value					0.003

VAS scale score comparison

Before examination and care, the difference of the VAS scale scores was not significant between the two groups (P > 0.05). After examination and care, the VAS scale scores significantly increased in both groups (P < 0.05). Compared to the control group, the VAS scale scores of patients in the observation group were significantly lower (P < 0.05) (Table 5).

Table 5 Comparison of Visual Analogue Scale scores between groups, mean ± SD.

Group	Number of cases	Before care	After care	t value	P value
Control group	60	26.53 ± 2.70	52.82 ± 2.63	-25.111	0.000
Observation group	60	26.23 ± 2.45	38.43 ± 2.45	-54.144	0.000
t value		0.638	30.967
P value		0.114	0.037

Patient care satisfaction comparison

Satisfaction with care was significantly better in the observation group compared to the control group (P < 0.05) (Table 6).

Table 6 Comparison of patient care satisfaction between groups, n (%).

Group	Number of cases	Very satisfied	More satisfied	Dissatisfied	Overall satisfied
Control group	60	16 (26.67)	23 (38.33)	21 (35.00)	39 (65.00)
Observation group	60	36 (60.00)	22 (36.67)	2 (3.33)	58 (96.67)
χ²					23.410
P value					0.000

DISCUSSION

CRC is a global health problem due to its high occurrence and death ratio[17]. As reported by GLOBOCAN, CRC ranked third in the number of new cancer cases reported globally in 2020 at 1931590 (10%) and second in the number of deaths caused by malignant tumors at 935173 (9.4%). CRC is the second and third most prevalent adult cancer among female and male patients, respectively. Moreover, it is the fourth most important cause of cancer deaths, accounting for approximately 9.2% of global deaths[18], with 5- and 10-year survival rates of 65% and 58%, respectively. The major causative determinant for CRC is age, with age-specific occurrence and mortality rates dramatically increasing over a lifetime[19]. The overall occurrence of CRC has recently declined in the over-50 age group but has increased in the under-50 age group[20]. In addition to age, the increased incidence has been associated with prolonged bowel inflammation and different lifestyle factors, such as physical inactivity, unbalanced diet, smoking habits, excess weight, and alcohol overconsumption, as well as comorbidities such as obesity, type 2 diabetes mellitus, and inflammatory bowel disease, which can be significantly reduced by improving disease management and implementing wellness programs[21-25]. Much of the CRC-associated morbidity and mortality is due to polyp and cancer-induced anemia, as well as CRC-induced bowel obstruction, weight loss, and metastasis[26]. Screening digestive endoscopy and polypectomy have been shown to reduce morbidity and mortality from CRC[27]. However, gastrointestinal endoscopy is an invasive procedure, which often exposes treatment and examination to adverse interventions. Currently, studies on gastrointestinal endoscopy focus on clinical value and less on care impact. Therefore, it is important to study the value of professional and systematic gastrointestinal endoscopy center care. In contrast to other studies, we systematically studied the intervention effect of digestive endoscopy center care on the psychological state and pain level of CRC patients and demonstrated the effectiveness and safety of digestive endoscopy center care through specific data. The study demonstrated that the SAS and SDS scale scores of patients in each group significantly decreased after nursing care (P < 0.05), and the VAS scale scores significantly increased after examination (P < 0.05). Compared to the control group, patients in the observation group had lower SAS, SDS and VAS scores after nursing care (P < 0.05), and significantly higher compliance and satisfaction with nursing care (P < 0.05).These data suggest that gastrointestinal endoscopy center care can significantly improve the psychological states and pain level of CRC patients and is significantly better than conventional care, likely in part because the care team in the gastrointestinal endoscopy center consists of endoscopic caregivers with professional knowledge and skills who provide personalized care for the specific needs of CRC patients. This specialized care not only effectively relieves patients' anxiety and uneasiness and enhances their trust and cooperation in treatment but also reduces discomfort during treatment and psychological stress triggered by pain through precise pain management, such as local anesthesia and analgesic drugs. At the same time, the nursing team focuses on patients' mental health, helping them overcome their fear of the condition and enhance their confidence in coping with treatment through timely psychological counseling and emotional support. The entire nursing process, including pre-examination preparation, post-examination recovery and emotional support, ensures that patients receive good psychological and physiological care during the treatment process, recovering quickly and avoiding the exacerbation of anxiety. By observing patient feedback in real time and quickly adjusting care measures, the nursing team can effectively alleviate discomfort and reduce patients' psychological burden. In addition, the Gastrointestinal Endoscopy Center provides more comprehensive treatment and care for patients through multidisciplinary collaboration, combining the cooperation of professionals such as gastroenterologists, nurses and psychologists to ensure the overall improvement of physical and mental status. However, this study has some key limitations, such as the single-center design, short-term follow-up and unmeasured confounders.

CONCLUSION

In conclusion, gastrointestinal endoscopy center care can effectively intervene in the psychological state and pain level of CRC patients, which provides value in the clinical setting. However, there are some problems in the clinical promotion and application of this study that need to be addressed. In clinical promotion, the problems of patient acceptance, professional differences among nursing staff, resource limitation and cost should be addressed, and strategies such as patient education, training, resource optimization and policy support should be adopted to ensure the effective implementation of digestive endoscopic nursing intervention. Coping strategies include strengthening patient education, regular training of caregivers, optimizing resource allocation and equipment conditions, and reducing costs through policy support to ensure widespread application of nursing interventions.