建立癌症病人化學治療免疫不全之臨床照護指引

Developing an Evidence-Based Clinical Guideline in Providing Nursing Care to Cancer Patients Receiving Myelosuppressive Chemotherapy in Hospital

楊惠玲(Huei-Ling Yang) ； 溫明寰(Ming-Huan Wen) ； 陳秀蓮(Shiu-Lien Chen) ； 林小玲(Shir-Ling Lin)

《榮總護理》 30卷2期 (2013/06) Pp. 166-180

https://doi.org/10.6142/VGHN.30.2.166

摘要

骨髓功能抑制是癌症病人接受化學治療常見合併症，影響血液正常功能導致病人發生白血球減少、貧血、血小板減少等免疫不全症狀，影響治療時間、增加發病率、死亡率及費用。本照護指引藉JBI實證模式分三階段進行：第一階段進行系統性文獻回顧法，搜尋2000－2010年文獻及嚴謹評析，收錄10篇系統性文獻回顧、1篇隨機對照研究及10篇臨床照護指引，建立臨床指引草案；第二階段舉辦2次專家焦點團體，邀請全國19位具癌症照護經驗專家，進行指引草案之效度檢定；第三階段採問卷調查法，調查十一所醫院179位臨床護理人員及19位專家對照護指引實施可行性之看法。結果確認本指引共70項，含白血球、紅血球、血小板評估22項、處置性照護31項與預防性照護17項，其中建議等級Grade A 60項，Grade B 10項。本文期望藉指引建立，製訂全國對癌症病人免疫不全評估檢查項目之一致性，增強護理人員評估及臨床照護能力，能於實務中運用多種預防處置策略，提供病人更有效益的照護品質。

關鍵字

骨髓抑制 ； 免疫不全 ； 化學治療 ； 臨床照護指引

並列摘要

Chemotherapy induced neutropenia, anemia, or thrombocytopenia are serious adverse events caused by cancer therapies that can have a significant impact on mortality, morbidity and health care costs. Based on JBI framework, a three-phase design was used to develop the clinical guideline. In Phase I, a comprehensive systematic review was conducted. Totally 21 studies had performed appraisal including 10 systematic reviews, 1 randomized control trial and 10 clinical guidelines during 2000-2010. In phase II, a two-session focus group was conducted to understand 19 clinical experts' experiences in caring for the cancer patients receiving chemotherapy and/or radiotherapy in their hospitals. In phase III, a survey was conducted to measure the feasibility of the clinical guideline which was built by the outcomes from phase I and II. In total, there were 179 clinical staff nurses and 19 clinical experts from 11 hospitals were invited to fill out the questionnaire. A 70-item clinical guideline was developed including 3 domains: 22 items of assessments for neutropenia, anemia, and thrombocytopenia, 31 items of managements in alleviating chemotherapy induced side effects and 17 items for preventive strategies. A total of 60 Grade A items and 10 Grade B items were recommended. These results might provide administrators with practical recommendations which can be used to ensure cancer therapy patient care safety, and to provide evidence-based information for clinical staff nurses.

並列關鍵字

myelosuppression ； immunodeficiency ； chemotherapy patients ； evidence-based clinical guideline

參考文獻

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