腫瘤個案管理師主導E化存活照護計畫對乳癌婦女治療相關生活品質的影響

The Effectiveness of Oncology Case Manager Led E-Based Survivorship Care Plan on Treatment-related Quality of Life for Women with Breast Cancer

洪彩慈(Tsai-Tzu Hung) ； 林麗玲(Li-Ling Lin) ； 周宜錦(I-Chin Chou) ； 李國鼎(Kuo-Ting Lee) ； 郭耀隆(Yao-Lung Kuo) ； 方素瓔(Su-Ying Fang)

《腫瘤護理雜誌》 22卷1期 (2022/06) Pp. 5-18

https://doi.org/10.6880/TJON.202206_22(1).01

摘要

目的：探討腫瘤個案管理護理師主導「E化存活照護計畫」對乳癌治療相關功能性及症狀生活品質之成效與影響因子，以及存活者對腫瘤個案管理護理師提供照護之滿意度。方法：本研究於2019年3月至2020年3月期間，納入診斷乳癌並完成手術或化學治療後一年內，有使用智慧型手機習慣的存活者（N = 162）。介入前與介入後三個月填寫生活品質乳癌次量表「EORTC QOL-BR23」，介入後三個月亦填寫對個案管理護理師提供「E化存活照護計畫」的滿意度量表。結果：控制年齡、期別、手術方式、化學治療及荷爾蒙治療的狀況下，「E化存活照護計畫」介入後「性功能」（p = .043）及「性滿意度」（p ＜ .001）次量表得分顯著改善。影響因子分析方面，年輕及未接受化學治療者性功能改善較年長及接受化學治療者顯著；年長、疾病較早期以及有接受化學治療者對健康展望較顯著改善；疾病較晚期手臂症狀較早期者顯著增加；年輕及有接受荷爾蒙治療者掉髮不適感顯著增加。100%的存活者認為腫瘤個案管理護理師「具良好的臨床知識及技能」且可「提供合適的健康照護資訊」。結論／實務應用：「E化存活照護計畫」具短期介入成效，且存活者對個案管理護理師提供的「E化存活照護計畫」具高滿意度，本研究可供未來發展癌症存活者照護之參考。

關鍵字

腫瘤個案管理師 ； 存活照護計畫 ； 乳癌存活者 ； E化資訊

並列摘要

Purpose: This study examined the effectiveness and related factors of E-based survivorship care plan on treatment-related functional symptom quality of life, and satisfaction with the care plans delivered by oncology nurse case manager for breast cancer survivors. Methods: The E-based survivorship care plan computerized application as an intervention was delivered by oncology nurse case manager in this study. Patients diagnosed with breast cancer, who had completed their primary treatment within one years and had smartphone (N = 162) were recruited from March 2019 to March 2020. Chinese version of the EORTC QOL-BR23, and the modified satisfaction scale for evaluating the satisfaction of providing survivorship care plan by the oncology case manager were administered on baseline and 3 month after the intervention. Results: After controlling age, cancer stage, surgical treatments, chemotherapy and hormonal therapy, sexual functioning (p = .043) and sexual enjoyment (p ＜ .001) improved significantly after receiving ＂E-based Survivorship Care Plan＂. Compared to women with older age and receiving chemotherapy, sexual functioning improved significantly among women with younger age and without received chemotherapy. In addition, the domain of quality on future perspectives improved significantly for women with older age, earlier stage and receiving chemotherapy. Arm symptoms improved significantly for women with advanced cancer stage. Upset by hair loss improved significantly in women with younger age and receiving hormone therapy. All survivors were satisfied with the care by oncology case manager and recognized nurse's role in ＂having good clinical knowledge and skills＂ and ＂providing appropriate health care information＂. Conclusions/Implications for practice: The breast cancer survivors found the ＂E-based Survivorship Care Plan＂ helpful and satisfying. Results of this study support the implementation of E-based survivorship care plan in clinical oncology care.

並列關鍵字

oncology case manager ； survivorship care plan ； breast cancer survivors ； E-based information

參考文獻

王育琳、方素瓔（2017）．E化癌症存活照護計畫之系統性文獻回顧．台灣醫學，21（6），555-567。[Wang, Y. L., & Fang, S. Y. (2017). A systematic review of e-based cancer survivor ship care plan. Formosan Journal of Medicine, 21, 555-567.] https://doi.org/10.6320/FJM.201711_21(6).0002

李昕宜、許玉娟、陳家慧（2014）．癌症生存者之困擾症狀．台灣醫學，18（3），355-360。[Lee, C. H. Y., & Xu, Y. J., Chen, C. C. H. (2014). Troublesome symptoms in cancer survivors. Formosan Journal of Medicine, 18(3), 355-360.] https://doi.org/10.6320/FJM.2014.18(3).12

陳晶晶、吳易霖、陳玉葉、洪彩慈、林貞伶、黃美智（2009）．護理角色的創新與拓展－成大醫院腫瘤個案管理模式介紹．護理雜誌 ，56（2），11-16。https://doi.org/10.6224/JN.56.2.11

Bjerkeset, E., Röhrl, K., & Schou-Bredal, I. (2020). Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: prevalence and characteristics. Breast Cancer Research and Treatment, 180(1), 63-71. https://doi.org/10.1007/s10549-020-05522-8

Chie, W. C., Chang, K. J., Huang, C. S., & Kuo, W. H. (2003). Quality of life of breast cancer patients in Taiwan: Validation of the Taiwan Chinese version of the EORTC QLQ-C30 and EORTC QLQ-BR23. Psycho-Oncology, 12(7), 729-735. https://doi.org/10.1002/pon.727