Research ArticleClinical Study on Effect of Solution Focused Approach on theComplications, Pain, Sleep, and Quality of Life in Patients withHepatocellular Carcinoma Undergoing TACE

Chunjie Ma,1 Yuexian Ma,2 Sidi Lu,3 Dan Li,3 Yan Wang,3 Yingxuan Xu,3 Tianyu Zhang,1

Youli Du,4 and Lulu Wang 5

1Department of CT, �e Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161006, China2Department of Nursing, �e Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161006, China3Department of Gastroenterology, �e Second Affiliated Hospital of Qiqihar Medical University, Qiqihar,Heilongjiang 161006, China4Department of Intervention,�e Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161006, China5Department of Anatomy, Qiqihar Medical University, Qiqihar, Heilongjiang 161006, China

Correspondence should be addressed to Lulu Wang; wanglulu9001@163.com

Received 18 August 2021; Accepted 3 September 2021; Published 15 September 2021

Academic Editor: Songwen Tan

Copyright © 2021 Chunjie Ma et al. +is is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective. +e objective of this study is to explore the effect of solution focused approach (SFA) on the complications, pain, sleep,and quality of life in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization (TACE).Methods. Total of 106 patients with hepatocellular carcinoma who underwent TACE in our hospital from July 2019 to June 2020were selected. According to the admission time, they were divided into the control group (n� 53) and the observation group(n� 53). +e control group implemented routine nursing intervention, and the observation group implemented SFA on the basisof the control group. +e clinical data, complications, pain, sleep status, and quality of life scores were compared between the twogroups. Results. +e total incidence of complications in the observation group (16.98%) was lower than that in the control group(33.96%) (P< 0.05). +ere was no significant difference in the score of pain perception between the two groups (P> 0.05). +escores of sleep status in the observation group were lower than those in the control group (P< 0.05).+e quality of life scores in theobservation group was higher than that in the control group (P< 0.05). Conclusion. SFA can effectively reduce the complications,relieve pain, improve sleep status, and improve the quality of life in patients with hepatocellular carcinoma undergoing TACE.

1. Introduction

Hepatocellular carcinoma is the cancer that originates fromhepatocyte or biliary tract cell. Patients with hepatocellularcarcinoma generally have no obvious symptoms in the earlystage. With the development of the disease, the symptoms ofhepatalgia, hypodynamia, anorexia, and ventosity may appear,which seriously affect the life safety of patients [1, 2].+e surveyshowed that in 2020, hepatocellular carcinoma ranks sixth inthe morbidity and ranks third in the mortality of cancers in theworld, and the number of patient increases year by year [3].Nowadays, transcatheter arterial chemoembolization (TACE)

is the effective method to treat hepatocellular carcinoma. It iseasy to be operated, less traumatic, economical, adaptive to awide range, and able to prolong the survival time of patientswith effective outcome [4, 5]. However, TACE generally bringspatients physical discomfort of different degrees which bringsnegative emotions that increase the psychological pressure ofpatients, influence the prognosis in a negative way, and reducethe quality of life of patients [6, 7]. +erefore, it is important totake scientifically reasonable nursing towards patients withhepatocellular carcinoma undergoing TACE.

At present, people’s expectation towards medical serviceis becoming higher and the nursing working mode is

HindawiEvidence-Based Complementary and Alternative MedicineVolume 2021, Article ID 5068228, 8 pageshttps://doi.org/10.1155/2021/5068228

changing. +e solution focused approach (SFA) is the in-tervening model that works through guiding individual tofind problems and set goals and then solves the problemsfocusing on the positive aspects of the individual. It has thecharacteristics of simple, effective, and affordable and hasplayed a key role in a variety of diseases such as overweightand diabetes [8, 9].+e SFA can fully explore the potential ofindividuals by guiding individuals to formulate scientific andfeasible plans, stimulate their subjective initiative, and en-hance their ability to manage themselves correctly so as tosolve the current problems and improve the living standardsof individuals. In addition, the SFA can not only intervenewith the physical state of the body but also affect the mentalhealth of the people. +is model can effectively mobilize theenthusiasm of individuals and improve the efficiency of theself-management and the meaning of life, reduce negativeemotions, and enable people to establish good beliefs andimprove the psychological resilience of individuals, which isa promising intervention approach.

+e SFA plays an important role in clinical treatment athome and abroad. However, research on the applicationeffect of SFA in patients with hepatocellular carcinomaundergoing TACE is relatively rare. Our physicians applySFA to patients with hepatocellular carcinoma undergoingTACE through the summary of clinical experience and theinquiry of the literature. +e paper is aimed to explore theeffect of SFA on the complications, pain, sleep, and quality oflife of patients with hepatocellular carcinoma undergoingTACE.

2. Materials and Methods

2.1. General Information. Total of 106 patients with he-patocellular carcinoma who underwent TACE in ourhospital from July 2019 to June 2020 were selected. +erewere 60 males and 46 females. +ey were aged from 39∼72years. +e mean age was (49.65 ± 5.13) years. Inclusioncriteria are as follows: being diagnosed with hepatocellularcarcinoma [10] and underwent TACE; the vital signs werestable after TACE; primary school education or above;being conscious; had independent reading ability andcould understand and complete questionnaires; and thepatients were agreed with the study. Exclusion criteria areas follows: having no need to take TACE; survival time <3months; having mental disease; dropping out during thestudy; and unable to communicate in normal language.+ey were divided into the control group (July 2019 toDecember 2019, n � 53) and the observation group (Jan-uary 2020 to June 2020, n � 53) according to the admissiontime.

2.2. Method. +e control group was taken care with the usualcare such as renal and liver function tests, prevention of in-fection, and notes instruction. At the same time, interventionsuch as psychological counseling and scientific knowledge ofhealth teaching was conducted on the control group.

+e observation group received SFA on the basis of thecontrol group. +e SFA nursing team was composed with

the head nurse, nurses who had received SFA professionaleducation. +ere was one time of intervention practice foreach patient, and the intervention time was 30–45 minutes.(1) Problem determination (Day 1 of admission): the basicinformation of the patients was obtained and it was assessed;nurse-patient communication was enhanced; the realthoughts of the patients were understood; the patient wasasked whether he or she is discomfort or not; and the pa-tients are guided to express the physical and psychologicalconditions, such as follows: “Do you have any problems withTACE? What are your thoughts about physical recovery?What is the quality of your recent sleep? What help wouldyou like to receive?” Based on the results, current problemswere determined. (2) Construct goals (Day 3 of admission):the patients were encouraged to construct correct andfeasible goals with the medical staff; the patient wasinstructed on how to cooperate; and the patients wereinstructed to hypothesize about what benefits and changes inconditions could be achieved after the problem was man-aged. “What are you going to do to solve the possiblecomplications of the TACE procedure? What methodswould you use for pain relief? How do you think what youcan do to improve sleep quality? If you can control dietaccording to doctor’s advice, exercise, and improve sleepstatus with care, you can ease the discomfort of the pro-cedure.” +e goals were organized to guide the patients toconfront the problem through communication sentences asmentioned above. (3) Explore the exception (3 days beforeoperation): +e patients were guided to carry out the plan;the patients were introduced detailed knowledge abouthepatocellular carcinoma; the basic principle, treatmentprocess, treatment effect, and precautions of TACE proce-dure were explained and they were helped to understand theimportance of applying TACE procedure; and nurses hadintroduced patients to the use of analgesics and the use ofanalgesics at the right time to maximize the effects of pain.After the use of analgesic drugs, the occurrence of analgesiceffects and adverse reaction symptoms were recorded indetail, and the patients were continuously assessed for pain.At the same time, nondrug analgesia was administered.Nursing staff guided patients to breathe deeply at a slowpace, talked to patients more, relieved their bad mood, andtransferred the attention of patients. Abdominal massagewas performed to relax the muscles and reduced abdominaltension to raise the pain threshold and relieved pain; dis-tracted patients’ attention through psychological suggestion,language comfort, and other measures to shift patients’attention and help them be active in fighting hepatocellularcarcinoma; helped patients recall the occasional improve-ment; and asked “How did the pain relief happen? How canthe exception continue to happen?” +rough the practicementioned above, we assisted patients to develop positiveperceptions. (4) Feedback on goals (1st day after operation):feedback was changed with the patient on reaching the goalwith giving affirmation and support; patients were en-couraged to continue the measures that work well; themethods that cannot work well were corrected; patients wereencouraged with words, “With your persistence, manyproblems have been solved; you are now able to face the

2 Evidence-Based Complementary and Alternative Medicine

effects of the disease positively.” (5) Goal evaluation (7th dayafter operation): the effectiveness of various aspects ofcomplications, pain perception, sleep status, and quality oflife were evaluated to encourage patients to make furtherefforts and to summarize and analyze the experience.

After the intervention, questionnaires were distributedto the patients and assessed by the trained research staff toobserve the effects of the intervention. Researchers explainedthe purpose of the survey and related requirements to pa-tients, and patients could fill in the scale with their consent.If patients could not fill in the scale in person, patients coulddictate it and staff could write it for them. A total of 106questionnaires were sent out, and 106 were effectively re-ceived with the effective recovery of 100.00%.

2.3. Observation Indicators. (1) Clinical data such as age,gender, classification of liver function, pathological stage,pathological type, Karnofsky Performance Status (KPS)score, and educational level were recorded for the twogroups. (2) Complications such as nausea and vomiting,fever, bleeding, and renal function impairment wererecorded in both groups. (3) Visual analogue scale (VAS)[11] was applied to mark the pain on a 10 cm horizontal lineaccording to the intensity of pain which was scored from 0 to10, with higher scores indicating stronger pain. All themeasuring actions were done by the same operator. +emarked points were data mined. (4) +e Pittsburgh sleepquality index (PSQI) [12] was applied, with 18 entries in-cluding sleep quality, time to fall asleep, sleep duration, sleepefficiency, sleep disorders, hypnotic drugs, and daytimedysfunction. Each item was scored according to the level of0∼3 points, and the accumulated score of each item wasPSQI total score ranging from 0 to 21 points with higherscores indicating poorer sleep. Cronbach’s α coefficient ofthe scale was 0.845. (5) +e Generic Quality of Life In-ventory-74 (GQOL-74) [13] was applied, with 74 itemsincluding physical functioning, psychological functioning,social functioning, and living status. +e total score of theinventory was 100 points. +e higher scores the patients gotindicated the quality of their life was better. Cronbach’s αcoefficient of the scale was 0.796.

2.4. Statistical Methods. SPSS 22.0 software was applied forprocessing. +e measurement data were expressed asmean± standard deviation (x ± s), and the t-test was appliedfor comparison. +e enumeration data were expressed as(%), and the χ2 test was applied for comparison. P< 0.05means that the difference has statistical significance.

3. Results

3.1. Comparison of Clinical Data between the Two Groups.+ere was no statistically significance of difference betweenthe two groups in the terms of age, gender, classification ofliver function, pathological stage, KPS score, pathologicaltype, and educational level (P> 0.05). For details, seeTable 1.

3.2. Comparison of Complications between the Two Groups.+e complication rate in the observation group (16.98%) waslower than that in the control group (33.96%), and thedifference had statistical significance (P< 0.05). For details,see Figure 1.

3.3. Comparison of Pain Sensation between the Two Groups.+ere was no significant difference in the score of painperception between the two groups (P> 0.05). For details,see Figure 2.

3.4. Comparison of Sleep Status between the Two Groups.All scores of sleep status in the observation group were lowerthan those in the control group, and the differences hadstatistical significance (P< 0.05). For details, see Figure 3.

3.5. Comparison of Quality of Life between the Two Groups.+e observation group got higher scores of quality of lifethan the control group. +e differences were statisticallysignificant (P< 0.05). For details, see Figure 4.

4. Discussion

In recent years, the incidence of hepatocellular carcinoma isgradually increasing and the population is getting younger[14]. TACE is an effective clinical treatment for hepato-cellular carcinoma, which can prolong patients’ survivaltime by interrupting the blood supply to the tumor andcausing tumor tissue necrosis [15, 16]. However, due to thedisease progression, discomfort during the treatment, andthe complications, patients undergoing TACE for hepato-cellular carcinoma are prone to negative psychologicalconditions, which increase the patients’ psychological bur-den and thus seriously affect their physical andmental healthand the prognosis [17]. +erefore, it is necessary to adopteffective nursing means for patients undergoing TACE forhepatocellular carcinoma.

SFA is an approach that focuses on the positive aspects ofthe individual and discovers as much as possible his or herown potential and resources to solve the problems [18].Karakaya’s and Ozgur team [19] reported that SFA plays animportant role in improving self-efficacy and self-esteemlevels in the adolescents with attention deficit hyperactivitydisorder. Aminnasab’s et al. team [20] conducted an in-vestigation on 30 patients with breast cancer and found thatthe levels of depression and perceived stress of patientssignificantly decreased after receiving SFA intervention, so itis necessary to conduct psychological evaluation of patientswith breast cancer clinically and conduct appropriate SFAintervention according to the results of the evaluation. Zhai’sand Zhu team [21] conducted a survey of 120 patientsundergoing vascular surgery. +e results showed that afterthe first and second weeks of SFA, the patients had betterprofile of mood states scores and symptom check-list-90scores, and the second week was better than the first week.+e results suggested that SFA was beneficial to reduce

Evidence-Based Complementary and Alternative Medicine 3

Tabl

e1:

Com

parisonof

clinical

data

betweenthetwogrou

ps(n,x±

s,%).

Group

Age

(years)

Gender

Classificatio

nof

liver

functio

nPa

thological

stage

Pathological

type

KPS

score

(points)

Educationallevel

Male

Female

Grade

AGrade

BI∼II

III∼IV

Unicellu

lar

carcinom

aCarcino

ma

Elem

entary

scho

olJunior

high

scho

olHighscho

olandabove

Con

trol

grou

p(n

�53)

49.28±7.50

31(58.49%)

22(41.51%)

40(75.47%)

13(24.53%)

29(54.72%)

24(45.28%)

36(67.92%)

17(32.08%)

72.65±8.19

16(30.19%)

23(43.40%)

14(26.42%)

Observatio

ngrou

p(n

�53)

50.03±7.69

29(54.72%)

24(45.28%)

41(77.36%)

12(22.64%)

30(56.60%)

23(43.40%)

34(64.15%)

19(35.85%)

74.02±7.86

18(33.96%)

20(37.74%)

15(28.30%)

t/χ2-value

0.508

0.153

0.052

0.038

0.168

0.878

0.361

Pvalue

0.612

0.695

0.819

0.844

0.682

0.381

0.835

4 Evidence-Based Complementary and Alternative Medicine

negative emotions and improve the psychological state ofpatients.

4.1. SFA Can Effectively Reduce the Complications. In thisstudy, compared with the control group (33.96%), the totalincidence of complications in the observation group

(16.98%) was lower.+e results showed that SFA can reducethe complications in patients undergoing TACE for he-patocellular carcinoma. We speculate that the reasons areas follows: in clinical practice, traditional nursing is usuallycarried out for patients undergoing TACE for hepatocel-lular carcinoma. Although it has a certain role in nursing, itcannot mobilize the self-ability and willingness of thepatients. SFA can unearth the positive power and potentialof patients undergoing TACE for hepatocellular carci-noma, develop an active way of thinking, mobilize theenthusiasm for treatment, and relieve the psychologicalcrisis. SFA can enable patients to actively participate intheir own management, with the characteristics of sub-jectivity and enthusiasm so as to achieve the goal of positivenursing and improve the ability to prevent complications[22].

4.2. SFA Can Effectively Relieve Pain Sensation. We foundthat there was no significant difference in the score of painperception between the two groups, but the score of painperception in the observation group was lower than that inthe control group. After summarizing many years of nursingexperience, the physician in our department believes that thepossible reasons are as follows: patients undergoing TACEfor hepatocellular carcinoma often have varying degrees ofpain sensation, which is closely related to the type anddosage of chemotherapy drugs, but nursing measures canonly relieve the pain sensation to a certain extent. +e SFAprogram focuses on introducing the knowledge of hepato-cellular carcinoma in detail to patients undergoing TACE forhepatocellular carcinoma and providing adequate healtheducation and helping them understand the importance ofapplying TACE surgery. At the same time, SFA can guidepatients to be inspired by the excavation of motive power,causing patients to divert their attention to active anti-cancer. In addition, SFA can use a variety of ways to distractpatients’ attention so that patients can actively seek effectivemeasures to reduce pain sensation and improve pain tol-erance, which has a certain improvement effect. Dargan’steam research reported that SFA was a method that aims toachieve patient goals by identifying and using the expertiseof patients. By implementing SFA for patients with chronicpain for 8 weeks, it could relieve pain and help patients withchronic pain diseases live a good and meaningful life. Ourresearch conclusion is roughly consistent with this con-clusion [23].

4.3. SFA Can Effectively Improve Sleep Quality. Becausepatients undergoing TACE for hepatocellular carcinomahave a sense of uncertainty about the development of thedisease, they are prone to a variety of adverse psychologicalproblems, which further lead to sleep disorders such asdifficulty in falling asleep, light sleep, and frequent awak-ening. In addition, painful stimulation may cause dys-function of the serotonin system and its receptors, leading torapid eye movement sleep deprivation, thereby reducing thequality of sleep in patients. +e results of this study showedthat the sleep of patients in the observation group was

Rate

of C

ompl

icat

ions

(%)

40

30

20

10

0

⁎

Control GroupObservation Group

Nau

sea a

nd V

omiti

ng

Feve

r

Hem

orrh

age

Rena

l Im

pairm

ent

Oth

er

Tota

l Inc

iden

ce

Figure 1: Comparison of complications between the two groups.Note: compared with the control group, ∗P< 0.05.

Control GroupObservation Group

Scor

e of P

ain

Perc

eptio

n (p

oint

)

8

6

4

2

0

Obs

erva

tion

Gro

up

Cont

rol G

roup

Figure 2: Comparison of pain sensation between the two groups.

Evidence-Based Complementary and Alternative Medicine 5

improved after the application of SFA. SFA can affect themental health of people, increase individual enthusiasm,establish confidence in overcoming difficulties, and effectivelyrelieve bad emotions. In addition, SFA can reduce the level ofpain sensation, thereby reducing the stimulation to the patientand improving the quality of sleep in patients [24].

4.4. SFA Can Effectively Improve the Quality of Life. SFA canguide patients to actively look for problems, formulatescientifically feasible goals, explore practices where excep-tions occur, listen to feedback, summarize and evaluate, and

divert patients’ attention to solutions to problems. +e SFAmodel provides health education to patients according totheir existing problems, stimulates their subjective initiative,and encourages patients to discover their own progress. Andit can enhance the confidence in fighting the disease so thatmakes patients realize their self-worth, fully mobilize theenthusiasm for life, and reduce the idea of avoiding andsuccumbing so as to eliminating difficulties and problemsand improve the standard of living. We found that theobservation group had a higher quality of life scores, whichsuggests that SFA can improve the quality of life of patientsundergoing TACE for hepatocellular carcinoma [25].

Sleep Quality Sleep Latency

Scor

e of P

SQI (

poin

t)2.5

2.0

1.5

0.5

0.0

1.0

⁎

⁎

Control Group

Observation Group

(a)

Sleep Time Sleep Efficiency

Scor

e of P

SQI (

poin

t)

2.5

2.0

1.5

0.5

0.0

1.0⁎

⁎

Control Group

Observation Group

(b)

Sleep Disorders Hypnotic Drug

Scor

e of P

SQI (

poin

t)

2.5

2.0

1.5

0.5

0.0

1.0

⁎

⁎

Control Group

Observation Group

(c)

Daytime Dysfunction Total Score

Scor

e of P

SQI (

poin

t)2.5

0.5

0.0

1.0

⁎

⁎

Control Group

Observation Group

(d)

Figure 3: Comparison of sleep status between the two groups. Note: compared with the control group, ∗P< 0.05.

6 Evidence-Based Complementary and Alternative Medicine

5. Conclusion

In conclusion, SFA can effectively reduce the complications,relieve pain, improve sleep quality, and improve the qualityof life in patients undergoing TACE for hepatocellularcarcinoma and is worthy of clinical application. With thetransformation of medical mode and the improvement ofpeople’s living standards, patients have more demands forcomfort during hospitalization. +rough the application ofSFA, it proves that as long as medical staff have a high senseof responsibility and focus on the patients and do a good jobof nursing from the details, they will be able to meet thehealth needs of patients.

However, it should be noted that the number of selectedcases in this study is small and only evaluated the patients’nursing efficiency in a short period of time. +erefore, it isstill necessary to carry out a large sample and long-terminvestigation in future studies, which will also become thefocus of our team’s future research.

Data Availability

+e data that are used or analyzed in the research can beobtained from the corresponding author upon reasonablerequest.

Ethical Approval

+is study was approved by the Ethics Committee of theSecond Affiliated Hospital of Qiqihar Medical University.

Conflicts of Interest

+e authors declare that there are no conflicts of interest.

Acknowledgments

+is study was supported by Foundation Project of Academyof Sciences of Qiqihar Medical University (QMSI2019M-27)and Clinical Research Project of Academy of Sciences ofQiqihar Medical University (QMSI2020L-07).

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Scor

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8 Evidence-Based Complementary and Alternative Medicine