建立肝癌病人癌症治療痊癒後續之臨床照護指引

Establishing an Evidence-Based Survivorship Care Guideline for Patients with Hepatocellular Carcinoma

楊惠玲(Huei-Ling Yang) ； 楊麗瓊(Li-Chiung Yang) ； 林宜演(I-Yen Lin) ； 陳怡岑(Yi-Tzen Chen) ； 林小玲(Shir-Ling Lin)

《榮總護理》 33卷2期 (2016/06) Pp. 112-125

https://doi.org/10.6142/VGHN.33.2.112

摘要

肝癌(Hepatocellular Carcinoma, HCC)是亞洲及非洲地區常見的惡性腫瘤，許多治療痊癒病人仍然必須面對疾病治療後長期的副作用。本研究目的乃針對國內肝癌治療痊癒者制定後續追蹤照護準則，本照護指引藉由JBI實證模式分三階段進行。第一階段進行系統性文獻回顧法，搜尋2005~2015年文獻及嚴謹評析，收錄6篇文獻回顧、5篇臨床指引、1篇隨機對照研究與2篇質性研究，建立臨床指引草案。第二階段舉辦1次焦點團體法，進行指引草案之效度檢定。第三階段採問卷調查法，調查8位臨床專家對照護指引實施可行性之意見。最後確認指引內容46項，包括追蹤期的訊息需求8項、身體生理層面照護20項、心理層面照護9項與營養照護9項。本文期望藉由建立肝癌治療痊癒照護指引及推動多學科後續追蹤照護計劃，以提升疾病恢復過渡期照護品質，並建議將此項治療痊癒照護指引擴大推展至其他癌症病人之後續照護。

關鍵字

實證照護 ； 肝癌病人 ； 治療痊癒者照護 ； 臨床照護指引

並列摘要

Hepatocellular carcinoma is a malignant neoplasm that commonly affects individuals from Asia. Many cancer survivors continue to face complicated care issues and side effects long after the completion of their treatments. The purpose of this study is to establish a survivorship care guideline for liver cancer patients and provide interdisciplinary strategic contentious plans for improving the quality of care for cancer survivors. A three-phased design was used to develop this clinical guideline. In phase I, a comprehensive systematic review was conducted. A total of 14 studies were appraised, including 6 systematic reviews, 5 clinical guidelines, 1 randomized-control trial, and 2 qualitative studies conducted during 2005- 2015. In phase II, a patient focus group was conducted to understand the experiences of cancer survivors. In phase III, a survey was conducted to measure the feasibility of the clinical guideline that was built according to the outcomes from phases I and II. Finally, 8 clinical experts were invited. A 46-item clinical guideline was developed including 4 domains: 8 items related to the continuous delivery of health information, 20 items related to physical and physiological care, 9 items related to mental support, and 9 items related to nutritional support. The result of this study is to develop a survivorship care guideline for liver cancer patients and to drive the multidisciplinary follow-up care plans to improve the transition care. This survivorship care guideline is also recommended for other kinds of cancer diseases.

並列關鍵字

evidence-based practice ； hepatocellular carcinoma ； survivorship care ； clinical practice guideline

參考文獻

穆佩芬(2014)．質性系統性文獻回顧法．源遠護理雜誌，8(3)，5-11。

Bosetti, C., Turati, F., & La Vecchia, C. (2014). Hepatocellular carcinoma epidemiology. Best Practice Research Clinical Gastroenterol, 28(5), 753-770.

Bower, J. E., Bak, K., Berger, A., Breitbart, W., Escalante, C. P., Ganz, P. A.,…Jacobsen, P. B. (2014). Screening, assessment, and management of fatigue in adult survivors of cancer: An American Society of Clinical oncology clinical practice guideline adaptation. Journal Clinical Oncology, 32(17), 1840-1850.

Chan, C. L., Wang, C. W., Ho, R. T., Ng, S. M., Chan, J. S., Ziea, E. T., & Wong, V. C. (2012). A systematic review of the effectiveness of qigong exercise in supportive cancer care. Support Care in Cancer, 20(6), 1121-1133.

El-Serag, H. B. (2011). Hepatocellular carcinoma. New England Journal of Medicine, 365, 1118-1127.