关键词: 膀胱癌, 永久性造口, 自我接纳, 变化轨迹, 决策树模型, 护理

Abstract:

Objective To explore the change trajectory of self-acceptance of patients with permanent urostomy，in order to provide basis for self-acceptance intervention practice of patients. Methods 168 patients with abdominal wall stoma with urinary diversion from June 2021 to June 2023 in Fudan University Cancer Hospital were selected as the survey subjects by convenience sampling. We used a general information questionnaire，SAQ，PTGI，SSRS，and COST-PROM. Baseline surveys were conducted a week after surgery（T0），and follow-up surveys were conducted at 1 month（T1），3 months（T2），and 6 months（T3） after discharge. The mixed model of latent variable growth was used to analyze the change trajectory of self-acceptance of patients with permanent urinary stoma，and the core predictors of each subtype were explored through the decision tree model. Results The number of patients who participated in the 4 surveys was 168，168，165 and 163，respectively，and the final questionnaire recovery rate was 97.02%（163/168）. The self-acceptance scores of patients with permanent urostomy were（35.72 ± 8.63） （36.81 ± 9.23） （39.88 ± 8.95） and（43.17 ± 9.56） points，respectively. The 3 subgroups of self-acceptance changes were identified，including low self-acceptance slow rising group（49.08%），medium self-acceptance first falling then rising group（30.06%），and medium self-acceptance fast rising group（20.86%）（P<0.001）. The decision tree model showed that education level，age，post-traumatic growth，social support，and economic burden could all predict the change track subtype of self-acceptance of patients with permanent urostomy，and the importance of post-traumatic growth was 100%. Conclusion The self- acceptance of patients with permanent urostomy is generally on the rise，and there is a population heterogeneity development track. Posttraumatic growth is the core predictor. It is important to identify the slow increase group of low self-acceptance according to the predictive indicators，and construct an intervention program focusing on improving the post-traumatic growth of patients with permanent urinary stoma to improve their self-acceptance level.

Key words: Bladder Cancer, Permanent Stoma, Self-Acceptance, Change Trajectory, Decision Tree Model, Nursing Care