建立初次診斷原發性膠質惡性腦瘤成年病人之臨床照護指引

Establishing Clinical Care Guidelines for Adult Patients Initially Diagnosed with Glioma

劉雅芬(Ya-Fen Liu) ； 黃子珍(Tzyy-Jen Huang) ； 張維琴(Wei-Chin Chang) ； 穆佩芬(Pei-Fan Mu) ； 溫美蓉(Mei-Rong Weng)

《腫瘤護理雜誌》 15卷2期 (2015/12) Pp. 51-67

https://doi.org/10.3966/168395442015121502005

摘要

多形性神經膠母細胞瘤（Glioblastoma Multiforme, GBM）為國內常見的惡性腦瘤，目前臨床上尚未針對初次診斷為原發性惡性腦瘤病人，建立由手術治療、放射線及口服化學治療至末期等整個病程的臨床照護指引。因此，本研究整合量性、質性系統文獻查證及統合分析（meta-analysis）、專家焦點團體及問卷調查等方式，建立臨床適用之照護指引。運用系統性文獻查證方法，於7個資料庫、9個網站搜尋2000-2010年國內外應用系統文獻查證發表之實證文章及臨床指引，依文章評析標準或工具，進行交互之文章評析、資料統合與分析，共納入3篇系統性文獻回顧、6篇臨床照護指引及2篇個案研究，歸納出三項策略：「手術照護策略」、「放射線及化學治療照護策略」及「病程後期心理支持策略」。並進行三場專家焦點團體討論會議，依逐字稿內容編組分類，彙整成適用性問卷，共確認90項照護重點，接著以問卷調查方式，調查22位焦點團體之專家及165位臨床醫、藥、護人員之意見，根據臨床照護指引實用性評估結果，實用性調查結果＜70%予以刪除後，最後共完成87項之「初次診斷原發性膠質惡性腦瘤病人之臨床照護指引」。本研究結果建議加強對於口服化療藥物之鼻胃管灌食防護認知，並應結合團隊模式對於初診斷惡性腦瘤病人疾病告知及支持的模式，以降低病人及家屬在初診斷及治療期、復發期至末期等所面臨之心理衝擊及提升因應能力。

關鍵字

原發性 ； 惡性腦瘤 ； 照護指引

並列摘要

Glioblastoma multiforme (GBM) is a common malignant brain tumor, for which a clinical care guideline hasn’t yet been established in our country to streamline the treatment course from surgical treatment, to radiation and oral chemotherapy, and late stage care for patients initially diagnosed with it. This study aimed at the building of such protocol through assessments of qualitative and quantitative studies, literature review and meta-analysis, focus groups experts opinions, and questionnaire surveys, etc. With the systematic literature verification method, 7 databases and 9 websites were searched for data published between 2000 and 2010 at home and abroad on evidence-based and clinical guidelines. After the evaluation of article comments on standards or tools, comparisons between reviews, data integration and analysis, 3 systematic review of the literature, 6 clinical care guidelines, and 2 case reports were included for study. Our result indicates three strategic directions: post-op care strategy, post-radiation and chemotherapy care strategy, and the psychological support strategy. Three focus-group workshops were conducted, in which a 90-focus questionnaire was produced, followed by a survey of 22 focus group experts and 165 clinicians and nursing staffs using the questionnaire for their opinions. 87 guidelines for the care of Glioblastoma multiforme (GBM) were built. According to our finding, the awareness and patient education of the post-treatment nasogastric tube feeding should be promoted. There should be team effort in informing the patient and family of the diagnosis and in the following support to help them come to term early and to cope better so that the impact of the diagnosis can be reduced when they face the initial treatment, the recurrence, or the end stage.

並列關鍵字

Primary malignant brain tumors ； Care guidelines

參考文獻

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