建立癌症病人蕈狀傷口照護之臨床照護指引

惡性腫瘤蕈狀傷口（Malignant fungating Wounds，MFW）是癌症照護常見的症狀，國內護理人員即使敏銳查覺到病人的需要，卻缺乏MFW相關的照護標準。本篇指引分六階段進行，第一階段成立工作小組及訂立涵蓋問題；第二階段文獻搜尋方法搜尋2014至2022年3月系統性文獻回顧（systematic review）及整合分析（meta-analysis）、臨床照護指引（clinical guideline）與隨機對照試驗（RCT）等；第三階段為系統性文獻回顧及臨床照護指引文獻評析與統整，經評讀後萃取實證等級Level 1a～3b之文獻共12篇，與3篇Grade A的臨床照護指引，共歸納出三個構面66項指引草案；第四階段係建構臨床照護指引效度，舉辦專家焦點團體，邀請機構內腫瘤照護專家共6位參與，依專家意見再經研究小組進行整理分析後，修正照護指引初稿；第五階段則進行臨床專家及照護人員指引可行性調查，專家對癌症病人蕈狀傷口之臨床照護指引整體同意程度98－100％，臨床護理師整體同意程度85－100％，故修正照護指引草案為三個構面共計37項；再經嚴謹的驗證及討論過程，建立符合本土化之癌症病人蕈狀傷口照護之臨床照護指引；第六階段為外部專家審閱，邀請三位外部專家，以AGREE II指引品質評估工具進行本指引之評價與建議，結果均大於70％。本文期望藉建立此本土化指引，透過實證依據建立具有適當性與可行性的臨床照護建議，協助護理人員在照護癌症病人蕈狀傷口時提供合宜的評估與處置。

關鍵字

癌症病人；蕈狀傷口；臨床照護指引

並列摘要

Malignant fungating wound (MFW) is a common symptom in cancer. Despite the need for a clinical practice guideline for patients with MFW, standardized strategies are unavailable. Thus, in the present study, we developed a clinical practice guideline for MFW care. The development process comprised the following six phases. In the first phase, relevant teams were formed and study questions were developed. In the second stage, a literature search was performed to obtain relevant systematic reviews, meta-analyses, clinical guidelines, and randomized controlled trials published between January 2014 and March 2022. In the third phase, the obtained systemic reviews and clinical guidelines were evaluated. A total of 12 level 1a-3b articles and 3 grade A clinical guidelines were identified. The first version of our MFW clinical guideline comprised 3 dimensions and 66 items. The fourth phase of the guideline development involved assessing the guideline's validity and conducting an expert focus group with six oncology experts. The fifth phase involved feasibility assessments by the experts and clinical nurses. The overall agreement was 98%-100% among the experts and 85%-100% among the clinical nurses. After rigorous inquiry, assessment, and discussion, the new, culturally adapted MFW clinical practice guideline was developed. The final version of the guideline comprised 37 items. In the sixth phase, the guideline was reviewed by three external experts who used the AGREE II guideline appraisal tool to evaluate our guideline and provide suggestions. All average scores exceeded 70%. Thus, by using evidence-based methods and performing adequate feasibility assessments, we developed an MFW clinical practice guideline. This tool may provide recommendations and evaluation strategies for clinical nurses caring for patients with MFW.

並列關鍵字

cancer ； malignant fungating wound ； clinical practice guideline

參考文獻

陳杰峰、邱文達(2008)．AGREE臨床指引之評估工具．台灣醫學，12(5)，584-590。

Adderley, U. J., & Holt, I. G. (2014). Topical agents and dressings for fungating wounds. Cochrane Database of Systematic Reviews, (5).

Aromataris, E., Fernandez, R., Godfrey, C. M., Holly, C., Khalil, H., & Tungpunkom, P. (2015). Summarizing systematic reviews: Methodological development, conduct and reporting of an umbrella review approach. International Journal of Evidence-Based Healthcare, 13(3), 132-140.

de Castro, D. L., & Santos, V. L. C. (2015). Odor management in fungating wounds with metronidazole: A systematic review. Journal of Hospice & Palliative Nursing, 17(1), 73-79.

Finlayson, K., Teleni, L., & McCarthy, A. L. (2017). Topical opioids and antimicrobials for the management of pain, infection, and infection-related odors in malignant wounds: A systematic review. Oncology Nursing Forum, 44(5), 626-632.

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