研究背景：甲状腺癌是内分泌系统最常见的恶性肿瘤，好发于育龄期女性，是目前发病率增长最快的恶性肿瘤，经过规范的诊治，可获得接近正常人的平均寿命，导致越来越多的年轻患者的生育需求日益凸显。由于甲状腺、甲状腺癌的治疗与生育密切相关，妊娠也会影响甲状腺癌的治疗，因此，育龄期女性甲状腺癌患者生育忧虑偏高，且她们生育相关知识缺乏，需要医护人员的专业指导。国内外目前还没有专门针对育龄期女性甲状腺癌患者生育忧虑的干预性研究，更鲜有信息支持对于生育忧虑的干预效果研究。因此有必要调查育龄期女性甲状腺癌患者的生育信息需求，并提供相应的信息支持，评价信息支持对降低生育忧虑的干预效果，从而降低她们的生育忧虑，安全度过妊娠期，提高其生活质量。

研究目的：

1.了解育龄期女性甲状腺癌患者生育信息需求

2.评价信息支持对降低育龄期女性甲状腺癌患者的生育忧虑的干预效果

研究方法：本研究分为两个部分。第一部分采用访谈法与问卷调查法了解育龄期女性甲状腺癌患者生育信息需求。首先采用目的抽样法，将符合纳入排除标准的16例患者作为访谈对象，归纳总结育龄期女性甲状腺癌患者不同生育阶段的生育信息需求的关注要点。依据前期访谈结果，参考相关文献，自制调查问卷，采用便利抽样的方法，将符合纳入排除标准的384例患者作为研究对象，了解育龄期女性甲状腺癌患者的生育相关信息需求。第二部分为干预性研究，结合第一部分调查结果，参考相关文献，并咨询专家，总结了育龄期女性甲状腺癌患者生育相关信息支持内容。采用便利抽样法，选取2023年1～6月北京协和医院普通外科收治的育龄期女性甲状腺癌患者35例为对照组，2023年7～12月收治的育龄期女性甲状腺癌患者34例为试验组。对照组给予常规健康教育，试验组在常规健康宣教的基础上接受生育信息支持，比较两组干预前、干预后以及干预后1个月的生育忧虑评分、生育知识评分情况。

研究结果：

1.调查结果显示：育龄期女性甲状腺癌患者在甲状腺与生育、甲状腺癌治疗与生育、甲状腺癌术后生育管理、妊娠期甲状腺癌生育管理、其他（碘营养、不良情绪应对方法）五个方面有信息需求。信息需求调查问卷中每一个条目的平均分均在2.81以上，信息支持方式76.15%选择教学视频的方式，信息支持地点88.79%选择线上进行。

2.干预研究，对照组35例，试验组34例完成研究。干预前，两组的生育忧虑评分和生育知识评分比较，差异无统计学意义（P>0.05）。（1）干预后，试验组生育忧虑评分（42.65±16.66）低于对照组（54.57±14.37），差异有统计学意义（P<0.05）；干预后1个月，试验组生育忧虑评分（41.76±15.47）低于对照组（51.89±15.22），差异有统计学意义（P<0.05）。干预后，试验组生育忧虑评分各维度中自身健康、子女健康、生育能力、备孕4个维度均低于对照组，差异有统计学意义（P<0.05）。干预后1个月，试验组生育忧虑评分各维度中自身健康、子女健康、生育能力3个维度低于对照组，差异有统计学意义（P<0.05）。（2）对照组育龄期女性甲状腺癌患者经过常规健康教育，干预后生育忧虑评分（54.57±14.37）较干预前（55.14±12.09）相比，差异无统计学意义（P>0.05）,干预后1个月生育忧虑评分（51.89±15.22）与干预前相比，评分降低但差异无统计学意义（P>0.05）;试验组经过生育信息支持，干预后，生育忧虑评分（42.65±16.66）较干预前（55.41±12.09）显著下降，差异有统计学意义（P<0.05）。干预后1个月生育忧虑评分（41.76±15.47）较干预前下降明显，差异有统计学意义（P<0.05）。（3）干预前，两组生育知识评分相比，差异无统计学意义（P>0.05）。干预后，试验组生育知识评分显著高于对照组，差异有统计学意义（P<0.05）。干预后1个月，两组生育知识评分比较，差异无统计学意义（P>0.05）。

研究结论：

1.育龄期女性甲状腺癌患者对生育信息支持的需求较高，需要甲状腺与生育、甲状腺癌治疗与生育、甲状腺癌术后患者生育指导、妊娠期甲状腺癌患者生育管理及其他（甲状腺癌患者碘营养及不良情绪应对方法）五个方面的知识，倾向选择线上的视频课程这类宽松的学习方式，便于需要时随时学习。

2.生育信息支持能够减轻育龄期女性甲状腺癌患者的生育忧虑，提高育龄期女性甲状腺癌患者的生育知识水平。

Background: Thyroid cancer is the most common malignant tumor of the endocrine system, and it is more common in women of childbearing age. It is currently the fastest-growing malignant tumor in terms of incidence, and after standard treatment, patients can achieve a life expectancy close to that of normal people. This has led to an increasing number of young patients expressing their desire for childbearing. Since thyroid and thyroid cancer treatment are closely related to fertility, pregnancy also affects the treatment of thyroid cancer, therefore, young women with thyroid cancer have a high level of fertility anxiety, and they lack knowledge about fertility. They need professional guidance from medical and nursing staff. There are currently no interventional studies specifically targeting the fertility concerns of young women with thyroid cancer in China or abroad, and there is even less information supporting the effectiveness of interventions for fertility anxiety. Therefore, it is necessary to investigate the fertility information needs of young women with thyroid cancer and provide corresponding information support to evaluate the effectiveness of information support in reducing fertility anxiety and lowering their fertility anxiety, enabling them to safely get through pregnancy and improve their quality of life.

Objective:

1.To investigate and understand the information requirement of childbearing period women with thyroid cancer.

2.To evaluate the application effect of patient-oriented fertility information support for childbearing period women with thyroid cancer.

Methods: The study was divided into two phases. In the first stage, using the methods of interviews and questionnaires, we investigated the fertility information needs of women of childbearing age with thyroid cancer. 16 patients in different gestational stages who met the exclusion criteria were selected in the study by purposive sampling. Interviews to explore their concerns of fertility information. Then, based on the results of previous interviews, with reference to relevant literature, self-made information demand scale was made to understand information requirement of by sending 384 questionnaires to childbearing period women with thyroid cancer by convenient sampling. The second stage is the intervention research. Based on the survey result of the first stage, reference to relevant literature, expert consultation to improve the information support content. By convenient sampling, a total of 69 childbearing period woman with thyroid cancer with fertility desire admitted in General surgical of Peking Union Medical College Hospital from January to December 2023 were selected as the research objects. They were divided into a control group (n=35, from January to June) and an intervention group (n=34, from July to December) according to their admission time. The control group was given routine health education and the intervention group received fertility information support based on the control group. The reproductive concerns after cancer scale (RCAC) score, fertility knowledge questionnaire were compared between the two groups after the intervention and 1 month later.

Results:

1.Interview shows that childbearing period women have information needs in 5 aspects. They are “Thyroid and Fertility”, “Treatment of thyroid cancer and Fertility”, “Fertility management after thyroid cancer surgery”, “Thyroid cancer management in pregnancy”, and others “Iodine nutrition and Bad emotions coping methods”. The average score of each item in the information needs questionnaire was above 2.81. 76.15% choose “video teaching” as the way of information support. 88.79% choose “online” as the mode of information support.

2.35 patients in the control group and 34 patients in the intervention group completed the study. Before the intervention, there was no statistically significant difference in the reproductive concern After Cancer (RCAC) scale score and fertility knowledge between the two groups (P>0.05).

(1) After intervention, RCAC scale score of the experimental group (42.65±16.66) was lower than that of the control group (54.57±14.37), and the difference was statistically significant (P<0.05). One month after intervention, RCAC scale score of the experimental group (41.76±15.47) was lower than that of the control group (51.89±15.22), and the difference was statistically significant (P<0.05).The four dimensions of own health, children's health, fertility ability and pregnancy preparation of the experimental group were lower than those of the control group, and the differences were statistically significant (P<0.05). One month after intervention, the three dimensions of own health, children's health and fertility ability and of RCAC scale score in the experimental group were lower than those in the control group, and the differences were statistically significant (P<0.05).

(2) In the control group, after routine health education, the reproductive concern After Cancer (RCAC) scale score (54.57±14.37) was not significantly different from that before intervention (55.14±12.09) (P>0.05). One month after the intervention, the RCAC scale score (51.89±15.22) was lower than that before the intervention, but the difference was not statistically significant (P>0.05). After the fertility information support, RCAC scale score of the experimental group (42.65±16.66) was significantly lower than that before the intervention (55.41±12.09), and the difference was statistically significant (P<0.05). One month after intervention, RCAC scale score (41.76±15.47) was significantly lower than that before intervention, and the difference was statistically significant (P<0.05).

(3) Before intervention, there was no statistically significant difference in the score of fertility knowledge between the two groups (P>0.05). After intervention, the fertility knowledge score of the experimental group was significantly higher than that of the control group, and the difference was statistically significant (P<0.05). One month after intervention, there was no statistically significant difference in the score of fertility knowledge between the two groups (P>0.05).

Conclusion

1.Female patients with thyroid cancer in childbearing age had a high demand for fertility information support, which required five aspects of knowledge: thyroid and fertility, thyroid cancer treatment and fertility, fertility guidance for patients with thyroid cancer after surgery, fertility management for patients with thyroid cancer during pregnancy and others (iodine nutrition and anxiety coping methods for patients with thyroid cancer). They prefer to choose relaxed learning methods such as online video courses, so that they can learn at any time when they need to.

2.Fertility information support can reduce the RCAC scale score and improve the fertility knowledge level of female patients with thyroid cancer of childbearing age.