運動、營養衛教介入對於結直腸癌患者疾病接受度成效探討

背景與目的：初次罹結直腸癌病人面臨恐懼與不安，且癌症治療會引起病人焦慮，而疾病接受度是自我對殘疾或失能的調適能力，本研究擬藉由運動及營養介入措施，提高直腸癌病人對疾病的接受度。研究方法：本研究採類實驗研究設計，於2013年9月3日起至2015年12月31日止，依收案條件選取新罹患結直腸癌個案。所有個案依住院日期分配至實驗組與對照組，實驗組給予運動及營養相關衛教課程，每次2小時共計2次。營養課程內容包含正確飲食觀念及與個案討論治療期間飲食方式，運動課程包含：教導受試者如何安全有效的進行有氧運動及阻力運動，對照組提供常規衛教措施，並以「失能接受度問卷」及自擬結構式問卷收集相關資料。SAS 9.3統計套裝軟體進行資料分析，並以廣義估計方程式(GEE)分析介入方案，對兩組在疾病接受度重複測量產生的相關性及影響。研究結果：本研究共收案73位，實驗組31位，對照組42位，兩組病人除癌症期別，其餘基本資料、前測疾病接受度均無顯著差異，以GEE分別比較實驗組及對照組在不同時間點疾病接受度得分，結果顯示實驗組無論在一個月後測及四個月後測，均與前測達統計上的顯著差異(p ＜ .001)，對照組僅在四個月後測與前測達統計上的顯著差異(p = .043)，進一步以GEE控制癌症期別後，發現疾病接受度在組別與時間交互作用部份達統計上的顯著差異。討論與結論：結果顯示實驗組其疾病接受度因介入措施而有所提升，因此建議臨床人員能給予病人運動、營養介入，並適時提醒應維持良好的飲食、運動習慣，以提高結直腸癌病人疾病接受度。

關鍵字

運動衛教；營養衛教；結直腸癌；疾病接受度

並列摘要

Introduction: Patients that are newly diagnosed with cancer often feel anxiety and tiredness induced by cancer therapy. Acceptance of disability (AOD) plays a key role in moderating adaptation to the illness or disability. This study examined the effect of exercise and nutritional health education on colorectal cancer patients' AOD. Method: This study used a quasi-experimental design. We enrolled a consecutive series of patients newly diagnosed with colorectal cancer according to inclusion criteria from September 3, 2013 to December 31, 2015 and randomly assigned them into experimental and control groups. The experimental group received an exercise and nutrition intervention program that comprised two 2-hour education sessions. The nutrition education included knowledge of an appropriate diet and discussion of the diet during the treatment period. Instructions on how to perform aerobic and resistance exercises safely and effectively were provided through the exercise education. The control group received routine care. Data were collected using an AOD questionnaire and self-report structured questionnaires. Data were analyzed using generalized estimating equation (GEE) analysis to evaluate the intervention program's effects on AOD in different patient groups. Result: A total of 73 patients were analyzed (31 for experimental group, 42 for control group). No significant difference between groups in baseline characteristics, except for the cancer stage, was found. The results of the GEE analysis revealed significant improvements in AOD scores between the pretest and posttest-1 and posttest-2 (both p ＜ .001) for the experimental group, while for the control group, the increase was evident only between the pretest and posttest-2 (p = .043). After adjustment for the cancer stage, a significant interaction between group and time was observed. Conclusion: This study revealed that nutrition and exercise could improve the patients' AOD. Patients should be provided with this intervention.