持續性營養照護成效暨改善專案－以接受化學放射治療頭頸癌病人為例

To Improve Quality of Continued Nutrition Care for Head and Neck Cancer Patients Receiving Concomitant Chemo- Radiotherapy (CCRT)

溫心璇(Shin-Shiuan Wen) ； 孫珮儀(Pei-Yi Sun) ； 蘇怡如(Yi-Ru Su) ； 林美瑩(Mei-Ying Lin) ； 黃綉雲(Shou-Yin Hung) ； 陳麗琴(Li-Chin Chen) ； 黃孟娟(Meng-Chuan Huang)

《臺灣膳食營養學雜誌》 11卷1期 (2019/06) Pp. 71-83

https://doi.org/10.6709/TJD.201906_11(1).0006

摘要

口腔癌合併化學放射治療的病人於治療期間常有咀嚼困難、口腔黏膜破損等問題，可導致營養不良及體重減輕進而延遲療程。因此本專案目的在於藉由跨領域合作照護模式及適當地營養資源注入，提升頭頸癌首次接受同步化學放射治療（concomitant chemo-radio-therapy, CCRT）病人營養會診涵蓋率、複診率及改善營養指標。故本專案改善策略規劃如下：一、簡化頭頸癌首次接受CCRT病人營養會診流程；二、結合院方社福支付營養指導費用，提供免費癌症營養諮詢門診；三、藉由資訊追蹤系統提升病人營養會診複診率，並監測其營養攝取改善成效（涵蓋率定義為營養師會診總人數／個案管理師轉介總人數；複診率定義為經營養師會診二次以上總人數／營養師會診總人數）。自2014年10月起在癌症中心設立「癌症營養諮詢門診」，營養諮詢服務總人數從82人增加至2016年180人，營養照護涵蓋率為86%，營養師會診複診率為61.6%。接受二次以上（含兩次會診）複診病人其熱量及蛋白質顯著提升（p ＜ 0.05）及會診前後平均體重維持平穩。挹注社會福利經費在營養指導共計114人，相當於為病人節省營養照會費用新台幣22800元整。故藉由癌症門診營養會診流程可近性改善，積極運用院方社福資源，跨團隊照護模式可改善頭頸癌首次接受CCRT病人接受營養師會診涵蓋率、複診率及營養素狀況。

關鍵字

頭頸癌 ； 營養會診

並列摘要

Upon receiving concomitant chemo-radio-therapy (CCRT) treatment, patients with head and neck cancer often encounter difficulties related to mucositis, swallowing and chewing problems, and malnutrition leading to weight loss or interruption of treatment. Therefore, our hospital launched a multi-department quality improvement project to improve rates of nutritional counseling and follow-up dietician visits for head and neck cancer patients receiving CCRT. Improvement strategies included (1) the establishment of a patient-centered dietician referral system at the hospital's Center of Cancer, (2) the provision of nutrition counseling for low-income patients supported by the hospital’s social fund, and (3) the formation of a computer management information system to track patient initial and continued use of nutritional counseling services. In October of 2014, we established the ＂Cancer Nutrition Consultation Clinic＂ at our hospital’s Center of Cancer. The number of patients counseled by dietician increased from eighty-two in October of 2014 to 180 by the end of 2016. Eighty-six percent of the 180 head and neck cancer patients referred to dieticians, and almost 61.6% (n = 98) of those who made initial visits made follow-up visits to dieticians. We found that those who sought follow-up nutrition counseling consumed significantly higher levels of energy and protein compared to those evaluated at the baseline visit. Besides, their body weights were maintained. The hospital social welfare fund was tapped to support the cost of nutrition counseling for 114 of these patients, totaling NT$22800. It was concluded that this multi-department quality improvement project for cancer nutrition care was successfully initiated and implemented and that the nutrition counseling clinic at the hospital's Center of Cancer improved dietician referral rates, nutritional intake and weight maintenance in head and neck cancer patients receiving CCRT.

並列關鍵字

head and neck neoplasms ； nutrition counseling