運用COPE問題導向介入措施於免疫治療之肝癌病人照護經驗

Zi-Xuan Gao; Mei-Chun Chen; Jui-Chun Chan; Yun-Hsiang Lee

doi:10.6880/TJON.202212_22(2).09

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P115 - 128

医药卫生 > 预防保健与卫生学
医药卫生 > 内科
医药卫生 > 社会医学

DOI： 10.6880/TJON

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运用COPE问题导向介入措施於免疫治疗之肝癌病人照护经验

Nursing Experience of Applying COPE Problem-Solving Intervention to Patient Care for Liver Cancer Undergoing Immunotherapy

高子媗(Zi-Xuan Gao) ；陈美君(Mei-Chun Chen) ；詹瑞君(Jui-Chun Chan) ；李芸湘(Yun-Hsiang Lee)

肿瘤护理杂志； 22 卷 2 期 (2022 / 12 / 01) ， P115 - 128

英文 DOI： 10.6880/TJON.202212_22(2).09

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摘要 │ 参考文献 (24) │ 国际计量

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Patients with cancer receiving immunotherapy are usually already in the advanced stage requiring second-line treatment, which greatly affects their physical and mental health. This study focused on a patient with advanced liver cancer who had experienced rare, severe Immune-related adverse events (irAEs) while receiving immunotherapy. The patient felt helpless and worried and was unsure how to cope. The author employed the creativity, optimism, planning, and expert information (COPE) problem-solving intervention as the study framework. Referencing empirical literature related to COPE, the researchers drafted concrete interventions to help the patient cope with health problems following immunotherapy. During the nursing period (May 12-27, 2020), the author collected data using face-to-face interviews, team discussions, and medical record consultations. The data indicated the patient had problems including muscle weakness, low immunity, and feelings of uncertainty. The author tracked daily changes in the patient's muscle weakness using Google Forms. Interdisciplinary team discussion with a physiotherapist resulted in the suggestion that the patient wear a support belt and be accompanied by caregiver when walking to prevent falls. Furthermore, the author intensively monitored the patient for signs of infection caused by low immunity and taught the patient measures to protect against infections. In addition, the author used the Mishel Uncertainty in Illness Scale to evaluate changes in the patient's feelings of uncertainty and encouraged their expression. The author also empathized with and guided the patient in thinking positively to achieve the following goals: (1) maintain muscle strength and joint mobility and prevent falls; (2) prevent reinfection; and (3) reduce feelings of uncertainty. Because this is the first case of a patient experiencing rare, severe irAEs while receiving immunotherapy, the author hopes this care experience can serve as a crucial reference for clinical nurses in the future.

参考文献 ( 24 ) 〈TOP〉

American Cancer Society(2019). Signs and Symptoms of Liver Cancer. Retrieved from https://www.cancer.org/cancer/liver-cancer/detection-diagnosis-staging/signs-symptoms.html#references
American Cancer Society(2020). Watching for and Preventing Infections. Retrieved from https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/infections/preventing-infections-in-people-with-cancer.html
El-Khoueiry, A. B.,Sangro, B.,Yau, T.,Crocenzi, T. S.,Kudo, M.,Hsu, C.,Kim, T. Y.,Choo, S. P.,Trojan, J.,Welling, T. H.,Meyer, T.,Kang, Y. K.,Yeo, W.,Chopra, A.,Anderson, J.,Dela Cruz, C.,Lang, L.,Neely, J.,Tang, H.,Melero, I.(2017).Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): An open-label, non-comparative, phase 1/2 dose escalation and expansion trial.The Lancet Oncology,389,2492-2502.
Germino, B. B.,Mishel, M. H.,Crandell, J.,Porter, L.,Blyler, D.,Jenerette, C.,Gil, K. M.(2013).Outcomes of an uncertainty management intervention in younger African American and Caucasian breast cancer survivors.Oncol‑ogy Nursing Forum,40(1),82-92.
Gille-Johnson, P.,Hansson, K. E.,Gårdlund, B.(2012).Clinical and laboratory variables identifying bacterial infection and bacteraemia in the emergency department.Scandinavian Journal of Infectious Diseases,44(10),745-752.

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