建立成人癌症病人疼痛非藥物處置之臨床照護指引

Establishment of a Non-pharmacological Cancer Pain Management Clinical Guideline for Adult Patients

10.6142/VGHN.29.2.145

黃惠美(Hui-Mei Huang)；郭素真(Shu-Chen Kuo)；王靜慧(Ching-Hui Wang)；張議文(I-Wen Chang)；周幸生(Shin-Shang Chou)

癌症疼痛 ； 非藥物處置 ； 臨床照護指引 ； cancer pain ； non-pharmacological management ； clinical guideline

榮總護理

29卷2期（2012 / 06 / 01）

145 - 158

繁體中文

疼痛是癌症病人最常見且困擾的症狀，結合藥物和非藥物措施更能達到有效的疼痛處理，但目前國內尚無癌症病人疼痛非藥物實證臨床指引，因此，本研究之目的乃藉由實證模式，建立癌症病人疼痛非藥物處置之臨床照護指引。研究第一階段進行系統性文獻查證，於10個資料庫、13個網站，搜尋2000~2010年系統性文獻回顧及臨床指引類型文章，依評析標準共納入14篇系統性文獻回顧、8篇臨床照護指引，建立65項臨床指引草案。第二階段進行2次專家焦點團體會議，邀請全國14位具癌症照護經驗專家，藉由其對於癌症病人疼痛非藥物處置臨床指引之專業觀點，指引草案修改至72項。第三階段以問卷調查14位專家及201位護理人員臨床指引之可行性。最後確認70 項指引，包含：綜論12項、評估12項、心理策略19項及生理策略27項；其中建議等級Grade A 58項、Grade B 12項。研究結果建議藉由在職教育，增強護理人員對癌症疼痛的評估及敏感度，加強癌症疼痛非藥物處置概念與技能，將癌症疼痛非藥物處置臨床照護指引融入實務中，結合運用多種處置策略，達到無痛醫院的目標。

Pain is one of the most important symptoms in cancer patients. The combination of pharmacological and non-pharmacological strategies achieve to effectively manage pain. At present, there were no non-pharmacological cancer pain management clinical guidelines for adult patients. The aim of this study was to determine the best available evidence-based practice in clinical settings on the non-pharmacological cancer pain management for adult patients. A 3-phase design was used to develop the clinical guideline. In phase Ι: A comprehensive systematic review and clinical guidelines pertaining to non-pharmacological management strategies were retrieved using 10 major databases and 13 websites with the literature searched from 2000 to 2010. Critical appraisal tools were used for data extracting. In phase Ⅱ: Two sessions of expert focus group were held to understand experts' experiences with non-pharmacological cancer pain management. In phase Ⅲ: A survey was conducted to evaluate feasibility of each intervention. The final clinical guidelines included four domains and 83 items, comprising 12-item general principles, 12-item assessments, 25-item psychological strategies, and 34-item physiological strategies. We suggest that the health care organization should provide more information regarding non-pharmacological cancer pain management strategies and combine various strategies to achieve the goal of pain-free hospital.