Abstract:

Objective To establish a full-chain follow-up system for tumor patients during chemotherapy and to evaluate its application effect. Methods A full-chain follow-up system was built according to the actual needs of cancer patients during chemotherapy，including 5 modules：patient health records，follow-up plan，risk identification and abnormal reminder，online consultation，interaction between doctors and patients and data visualization analysis and intelligent statistical management. Convenience sampling method was used to select 96 patients with tumor at chemotherapy stage who were treated in a tertiary A hospital in Deyang City，Sichuan Province from February to June 2023 as a test group，and the full chain follow-up system for tumor patients at chemotherapy stage was applied for follow-up;93 patients with tumor at chemotherapy stage were treated from February to June 2022 as a control group for routine follow-up care. Indicators of self-management ability，quality of life and satisfaction with follow-up services were compared between the 2 groups before and after the application of the system. Results 94 cases in the test group and 92 cases in the control group completed the study. After the application of the system，the test group scored（169.44±11.96） on the Cancer Patients Self-Management Scale，higher than（150.76±13.44） in the control group. The score on the Cancer Patients Quality of Life Core Scale was（65.50±7.90），higher than（59.81±7.27） in the control group. The score on the Questionnaire of Satisfaction with the Follow-Up Service was（52.00±3.30），higher than（48.89±3.54） in the control group，and the difference between the 2 groups was statistically significant（P<0.001）. Conclusion The application of the full-chain follow-up system can meet the diversified and multi-level follow-up needs of tumor patients during chemotherapy，achieve accurate，professional and intelligent nursing follow-up services，effectively improve patients’ symptom self-management ability and quality of life，and improve patients’ satisfaction with nursing services.

Key words: Chemotherapy Period, Artificial Intelligence, Full Chain, Follow-Up System, Continuous Nursing, Oncologic Nursing

摘要：

目的 构建化疗期肿瘤患者全链式随访系统，并评价其应用效果。方法 基于患者实际需求，构建化疗期肿瘤患者全链式随访系统，包括健康档案、随访计划、风险识别与异常提醒、医护患在线咨询与交互、数据可视化分析及统计智能化管理5个模块。采用便利抽样法，选取2023年2月—6月在四川省德阳市某三级甲等医院就诊的96例化疗期肿瘤患者作为试验组，应用全链式随访系统进行随访;将2022年2月—6月就诊的93例化疗期肿瘤患者作为对照组，实施常规随访护理。系统应用前后对两组自我管理能力、生活质量及随访服务满意度指标进行比较。结果 试验组94例、对照组92例完成研究。系统应用后，试验组癌症患者自我管理测评量表得分为（169.44±11.96）分，高于对照组的（150.76±13.44）分;癌症患者生命质量测定量表得分为（65.50±7.90）分，高于对照组的（59.81±7.27）分;随访服务满意度调查问卷得分为（52.00±3.30）分，高于对照组的（48.89±3.54）分，两组比较，差异均具有统计学意义（P<0.001）。结论 全链式随访系统的应用满足了化疗期肿瘤患者多样化、多层次的随访需求，实现了精准化、专业化、智能化的护理随访服务，有效提升了患者的症状自我管理能力和生活质量，提高了对护理服务的满意度。

关键词: 化疗期, 人工智能, 全链式, 随访系统, 延续性护理, 肿瘤护理