- 期刊
化療引致噁心嘔吐非藥物處置之臨床照護指引
Clinical Guideline for Non-pharmacologic Interventions Pertaining to Chemotherapy-induced Nausea and Vomiting among Cancer Patients
摘要
噁心嘔吐是化學治療常見的副作用，各醫院雖有照護常規，但未有實證基礎之非藥物處置臨床照護指引。本篇照護指引分三階段進行，第一階段運用系統性文獻查證及評析，搜尋2005-2010年發表之文章，經評讀後萃取實證等級Level I之文獻，共十一篇，予歸納後非藥物處置共20項；第二階階段舉辦專家焦點團體進行效度檢定，邀請北、中、南部腫瘤照護專家共18人，經團體過程內容分析整理後形成16項；進而統合二階段項目，刪除重覆3項，形成照護指引問卷33項，包括：噁心嘔吐評估、非藥物之生理性策略及心理性策略等三個構面；第三階段進行照護指引可行性調查，結果可行性≦ 70%有4項，刪除其中兩項、保留據證據等級Level I兩項，最後可被接受用於臨床之指引有31項，其中Grade A（65%）、Grade B（35%）。因此，本研究形成了符合國人文化之化療引發噁心嘔吐非藥物處置臨床照護指引，但因項目較多，建議未來宜再發展可行的群集照護（bundle care），方便臨床使用，以提昇癌症照護品質。
並列摘要
Chemotherapy induced nausea and vomiting (CINV) is a common side effect of chemotherapy regimens among cancer patients. The aim of this project was to construct an evidence-based guideline for non-pharmacologic interventions pertaining to CINV. Three phases of study designs were used to develop the clinical guidelines. In phase III, a comprehensive systematic review was conducted. A totally of 11 studies had performed appraisal during 2005-2010, formatting 20 items of guidelines. In phase II, an expert focus group was formed to examine the validity of guidelines and to collect their opinions. There were a total of 18 clinical experts from three districts (north, central, and south) for two groups, formatting 16 items of guidelines. The questionnaires of guideline deleted the overlapping 3-item and finally maintained 33-item. In phase III, a questionnaire survey was conducted to evaluate the feasibility of the 33-item guideline. The results deleted the 2-item from the feasibility validation ratio ≦ 70% of total items. A 31-item guideline was developed including 3 domains: assessment of nausea and vomiting, physiological and psychological non-pharmacologic interventions. Most of grades of recommendation were grade A (65%), but about 35% of guidelines were analyzed from the content of focus group from oncology experts. Finally, the development of clinical guidelines for non-pharmacologic interventions pertaining to CINV meet needs of localized culture in Taiwan. However, there were more items of the clinical guidelines. Therefore, the outcomes suggest that the future should be further development of feasible bundle care, and facilitate the clinical practice to enhance the quality of care for cancer patients.