Development of Clinical Pathway for Patients with Thyroid Carcinoma Undergoing Radioactive Iodine-131 Therapy: A Preliminary Study

甲狀腺癌患者接受放射性碘-131治療臨床路徑之建立

董曉萍(Hsiao-Ping Tung) ； 鄭澄意(Cheng-Yi Cheng) ； 黃文盛(Wen-Sheng Huang)

《核子醫學雜誌》 17卷4期 (2004/12) Pp. 203-209

https://doi.org/10.6332/ANMS.1704.004

摘要

背景：罹患甲狀線癌患者於手術切除甲狀線後多輔以放射性碘-131治療。文獻中對於甲狀線癌之治療及甲狀腺切除術後之照護多所探討，然對於接受放射性碘-131治療之臨床路徑則未有所述。本文之目的旨在藉由文獻探討與專家討論之方式建立接受放射性碘-131治療之臨床路徑。
方法：藉向病歷之分析統計，以探討其適用性與相關變異。
結果：於本院接受放射性碘-131治療之患者中，約60%之患者適用本臨床路徑。影響此路徑順利進行之因素多與照護者有關，就照護者變異而言，多係由於週末之照護人力不足以致延長病患住院天數。此一發現實可作為人力運用之參考。
結論：儘管口服高劑量碘-131治療之患者是否適用於本臨床路徑仍有待評估，然而，經由文獻統整及專家意見整合所建立之臨床路徑確有其臨床意義。臨床上，使用此臨床路徑時，常見影響該臨床路徑之變異多與照護者相關。臨床路徑之發展目的除縮短住院天數外，尚能減低醫療成本，然本研究並未針對經濟效益進行分析，建議未來之研究可對此進行探討。

關鍵字

臨床路徑 ； 放射性碘-131治療 ； 甲狀腺癌

並列摘要

Backgrounds: Nuclear medicine and general surgery are often interacted in the management of patients with thyroid cancer. Although certain controversies exist regarding the therapy, (superscript 131) I ablation therapy plays a major role in the postoperative treatment regimen. Rationale that supports the use of (superscript 131) I ablation as an adjuvant therapy was evidenced in several studies. Also, the well established clinical practice guidelines for thyroid disease have been addressed in previous articles. However, neither relevant nor specific clinical pathway has been developed for the (superscript 131) I treatment. The purpose of this preliminary study is to develop the clinical pathway for the (superscript 131) I therapy.
Methods: By a systemic peer review of relevant articles, a clinical pathway was developed. Following that, a prospective analysis of medical records of patients who were diagnosed as thyroid carcinoma underwent (superscript 131) I therapy was implemented to determine the appropriateness of the pathway and track the variances.
Results: The pathway was appropriate for more than 60% of these patients. The most prevalent variance was caregiver-related. In such variance, patients stayed longer than the defined length of stay (LOS), thus, were not to be discharged on the target day. One of the possible reasons for this was because of the shortage of staffing during weekend. It could be considered as one of the factors determined the ideal staff-patient ratio.
Conclusion: Whether this 3-day pathway is available for a large dose of oral radio-iodine treatment remain to be determined. Further study could focus on analyzing cost-effectiveness and assessing patients' satisfaction as well as the comparison of the LOS between different doses administered.

並列關鍵字

clinical pathway ； iodine-131therapy ； thyroid carcinoma