多媒體影音提升乳癌放射線治療病患自我照護之成效分析

Effectiveness analysis of multimedia audio-visual courses in improving self-care for breast patients with radiotherapy

楊蕙芳(Huei-Fang Yang)

指導教授 ： 張文瑋

中山醫學大學/醫學科技學院/生物醫學科學學系/碩士(2022年)

https://doi.org/10.6834/csmu202200073

摘要

接受放射線治療的患者，約有9成病患產生副作用，並因照射部位不同而有不同的反應，例如:皮膚反應、白血球低下、便秘、腹瀉等。在接受放射治療前護理人員都會給予自我照護護理衛教，然而由於臨床業務繁忙等因素，使護理人員衛教時間被壓縮，易產生片段性指導內容缺乏完整性，進而導致病患自我照護認知錯誤，副作用程度也因自我照護執行不確實而嚴重度增加。因此，本研究的目的，則希望透過製作多媒體衛教影音影片降低病人對放射治療後自我照護的錯誤認知，以及減輕臨床護理師的工作負擔，並且與傳統紙本衛教單張作比較，分析多媒體影音衛教影片對乳癌患者在放射治療後自我照護的成效。主要的收案對象為乳癌初次接受放射線治療患者，研究設計則將患者分為實驗組及對照組，分別給予多媒體衛教影片(以掃描QR-CODE方式取得)或紙本衛教單張，並皆提供口頭輔助衛教；而在開始治療前，所有參與者皆須填寫自我照護認知評核表（前測），而治療開始的第二週給予放射治療自我照護認知評核表（後測）及衛教滿意度問卷調查；以患者對於接受放射線治療的自我照護認知度之前後測及衛教滿意度之得分差異情形進行統計分析。研究結果發現，實驗組病人皆完整看完教材，而對照組僅45%患者看完衛教單張內容。於「放射線治療病患對治療自我照護」的分析結果發現，對照組正確認知率由10.9%提升至79.1%，實驗組正確認知率由24.8%提升至98.5%，結果顯示兩組間均有提升認知率，但由兩組認知評核的前後測答對題數比較，介入前兩組皆無受試者6題全答對，介入後6題全對者在對照組為32.73%(18人)，在實驗組為94.55%(52人)，達統計顯著差異(P＜0.001)。多媒體影音衛教組在介入後，受試者的滿意度則明顯優於傳統紙本衛教單張組。然而在衛教滿意度上，傳統紙本衛教單張組則顯著高於多媒體影音衛教組。總結來說，多媒體影音使用，不僅減輕護理師重複指導的負擔，降低醫療成本、且病患能依需求與便利性透過讀取QR-CODE重複觀看影片，將自我照護衛教正確落實運用在實務上，亦能降低病患對初次治療未知不安與焦慮且達到全人的照護。基於本研究成果，建議未來可發展各種癌別的多媒體影音護理衛教工具，並以不同族群語言分別製作，對外網站上亦可建立衛教專欄或護理指導影音資庫，以利民眾與病患查詢；此外，護理人員在使用多媒體影音衛教的期間，仍須留意與病人間的雙向溝通，以維持良好的醫病關係。

關鍵字

放射線治療 ； 多媒體衛教影音 ； 自我照護

並列摘要

For patients receiving radiation therapy, 90% of patients have side effects, and they have different reactions due to different irradiation sites, such as skin reactions, leukopenia, constipation, and diarrhea. Registered professional nurses (RPNs) provide self-care education documents before receiving radiotherapy. However, patients' wrong cognitions often occur due to busy clinical practice to compress education time and the incomplete guidance content. In addition, poor self-care implementation also leads to the un-improvement of side effects. Therefore, the purpose of this study is to reduce the workload of RPNs and decrease misunderstanding of self-care after radiotherapy among breast cancer patients who were receiving radiotherapy for the first time by providing multimedia health education videos and evaluating the effectiveness in comparison with the traditional printed document. The participants were divided into multimedia health education videos (obtained by scanning a QR-CODE) as the experimental group and printed education documents as the control group. The oral auxiliary health education was provided for both groups of participants. All participants were required to fill in a self-care cognitive assessment form before radiotherapy (so-called pre-measurement). The participants were requested to fill in the same self-care cognitive assessment form and a satisfaction questionnaire of health education in the second week of treatment (so-called post-measurement). We found that all the participants in experimental group completely read the education documents, while only 45% of those in control group done. In the analysis of self-care awareness, the correct rate of the control group increased from 10.9% to 79.1%, while it increased from 24.8% to 98.5% in experimental group. Before intervention, none of participant correctly answered all 6 questions in self-care questionnaire. After the intervention, there was 32.73% (18 people) and 94.55% (52 people) of participants in control or experimental group who correctly answered all the questions, which indicated that multimedia health education videos significantly improved the self-care awareness in compared to the traditional printed document (P<0.001). The experimental group displayed significantly better post-intervention satisfaction than the control group. However, the control group's satisfaction rate in health education was significantly higher than the experimental group. In conclusion, the use of multimedia self-care education videos providing through scanning a QR-CODE could relieve the burden of repeated guidance by RPNs and reduce medical costs. Patients can repeatedly watch the self-care education video according to their needs, which could be convenient and reduce the anxiety of patients due to the initial treatment followed by the achievement of holistic care. It suggests that various multimedia audio-visual nursing care education tools in different languages for cancer can be developed in the future. Furthermore, RPNs must pay attention to two-way communication with patients during the use of multimedia audio-visual education to maintain a good provider‑patient relationship.

並列關鍵字

Breast cancer Radiation therapy ； Multimedia audio-visual education ； Self-care education

參考文獻

謝德熾、陳立奇（2010）‧乳癌治療之演進‧北市醫學雜誌，7（3），313-322。

黃品逸、顏上惠(2008)•放射線治療在乳癌的使用•中華民國癌症醫學會雜誌，24(2)，121-126。

中文文獻

行政院衛生福利部國民健康署(2021)。2020年癌症登記報告。

財團法人台灣網路資訊中心2019台灣網路報告https://report.twnic.tw/2019/ 。