整合性癌症照護模式對口腔癌首次手術病人症狀困擾及健康照護需求之效果評價

Effectiveness of an Integrated Cancer Care Program on Symptom Distress and Health Care Needs of Initial Operative Patients with Oral Cancer

10.6142/VGHN.34.3.227

張碧華(Pi-Hua Chang)；張家慧(Chia-Hui Chang)；周玉書(Yu-Shu Chou)；林錦津(Chin-Chin Lin)；賴秀津(Hsiu-Chin Lai)；江佩蓉(Pei-Jung Chiang)；程稚盛(Chi-Sheng Cheng)；黃佩菁(Pei-Ching Huang)

整合性癌症照護 ； 口腔癌 ； 手術 ； 症狀困擾 ； 健康照護需求 ； integrated cancer care ； oral cancer ； surgery ； symptom distress ； health care needs

榮總護理

34卷3期（2017 / 09 / 01）

227 - 238

繁體中文

口腔癌手術造成病人身體外觀及生活重心改變，迫切需要疾病與治療相關的照護活動，以因應突如其來的衝擊。本研究目的為評價口腔癌首次手術病人接受「整合性癌症照護模式」在症狀困擾及健康照護需求的差異。研究方法採縱貫性實驗設計，對象為2015年5月～2016年6月中部某醫學中心口腔癌首次手術病人，共收案96人，對照組49位；實驗組47位。實驗組於住院期間接受「整合性癌症照護模式」服務；對照組為常規性照護。研究工具為基本屬性及疾病/治療資料、症狀困擾量表及健康照護需求量表，測量時間在手術前、出院前、出院後1個月及3個月。結果顯示「整合性癌症照護模式」執行率為89.4%，實驗組出院前心理健康照護需求顯著低於手術前(β=-.353, p=.028)；實驗組症狀困擾在出院後1個月(β=.152, p=.028)及3個月(β=.141, p=.044)顯著高於對照組；共變項以化學治療因素影響較顯著；兩組在身體及社會健康照護需求則無差異。建議調整「整合性癌症照護模式」之連續性照護時間，以利了解提供減緩症狀與滿足需求的新契機，以達整合性照護的價值與意義。

Background: Patents with oral cancer require urgent disease and treatment-related care to cope with the impact of facial disfigurement and changes in life focus due to surgery. Purpose: This study evaluated the effectiveness of an integrated cancer care program on the symptom distress and health care needs of patients with oral cancer. Methods: A longitudinal and experimental design was adopted for this study. We provided the integrated cancer care program to patients with oral cancer who had undergone initial surgery during hospitalization. All patients were evaluated at four time points: presurgery (baseline, T1), predischarge (T2), 1 month postdischarge (T3), and 3 months postdischarge (T4). Data were analyzed using a generalized estimating equation. The followed variables were symptom distress and health care needs (with physical, psychological, and social dimensions). Results: A total of 96 participants were recruited and randomly assigned to a control group (n= 49) and experimental group (n= 47). Partients in the experimental group received the integrated cancer care program at a medical center in central Taiwan. The executive rate of the program was 89.4%. Fatigue and dry mouth were two recurring symptoms in both groups from presurgery to 3 months postdischarge. The predischarge mental health care need was lower in the experimental group than in the control group (β= -.353, p= .028). Because of chemotherapy, symptom distress at 1 (β= .152, p= .028) and 3 (β= .141, p= .044) months postdischarge was higher in the experimental group. No significant changes in physical and social health care needs were observed. Conclusions and implications: Overall, the study results revealed that the multidisciplinary medical team could reinforce the functions of the integrated cancer care program and assist patients with oral cancer in coping with disease and treatment-related changes. Thus, the program implemented in this study was deemed successful in improving symptom distress and reducing health care needs among patients with oral cancer.

1. 張美玉、徐莞雲、徐倩儀、林麗英(2016)。新診斷癌症病人生活品質之相關因素探討。榮總護理，33(3)，293-302。
   連結：
2. 黃惠美、周幸生、陳玉枝(2014)。乳癌無縫服務─以某醫學中心實證模式建構整合性乳癌病人照護為例。源遠護理，8(2)，5-11。
   連結：
3. 衛生福利部國民健康署(2016)． 中華民國103 年癌症登記報告． 取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=269&pid=7330
4. Borras, J. M.,Albreht, T.,Audisio, R.,Briers, E.,Casali, P.,Esperou, H.,Wilson, R.(2014).Policy statement on multidisciplinary cancer care.European Journal of Cancer,50(3),475-480.
5. Bruera, E.,Hui, D.(2010).Integrating supportive and palliative care in the trajectory of cancer: Establishing goals and models of care.Journal of Clinical Oncology,28(25),4013-4017.
6. Chen, S. C.,Liao, C. T.,Lin, C. C.,Chang, J. T. C.,Lai, Y. H.(2009).Distress and care needs in newly diagnosed oral cavity cancer patients receiving surgery.Oral Oncology,45(9),815-820.
7. Coleman, K.,Austin, B. T.,Brach, C.,Wagner, E. H.(2009).Evidence on the chronic care model in the new millennium.Health Affairs,28(1),75-85.
8. Henselmans, I.,Helgeson, V. S.,Seltman, H.,de Vries, J.,Sanderman, R.,Ranchor, A. V.(2010).Identification and prediction of distress trajectories in the first year after a breast cancer diagnosis.Health Psychology,29(2),160-168.
9. Huang, B.,Chen, H.,Deng, Y.,Yi, T.,Wang, Y.,Jiang, Y.(2016).Diagnosis, disease stage, and distress of chinese cancer patients.Annals of Translational Medicine,4(4),73.
10. Jesse, M. T.,Ryan, M. E.,Eshelman, A.,Ghanem, T.,Williams, A. M.,Miller-Matero, L. R.,Yaremchuk, K.(2015).Integrated psychological care in head and neck cancer: Views from health care providers, patients, and supports.The Laryngoscope,125(6),1345-1351.
11. Kodner, D. L.,Spreeuwenberg, C.(2002).Integratedcare: Meaning, logic, applications, and implications - a discussion paper.International Journal of Intergrated Care,2(4),e12.
12. Mignogna, M. D.,Fedele, S.,Russo, L. L.(2004).The world cancer report and the burden of oral cancer.European Journal of Cancer Prevention,13(2),139-142.
13. Mochizuki, Y.,Matsushima, E.,Omura, K.(2009).Perioperative assessment of psychological state and quality of life of head and neck cancer patients undergoing surgery.International Journal of Oral and Maxillofacial Surgery,38(2),151-159.
14. O'Connell, B.,Kristjanson, L.,Orb, A.(2000).Models of integrated cancer care:A critique of the literature.Australian Health Review,23(1),163-178.
15. Ouwens, M. M.,Hermens, R. R.,Hulscher, M. M.,Merkx, M. A.,van den Hoogen, F. J.,Grol, R. P.,Marres, H. A.(2009).Impact of an integrated care program for patients with head and neck cancer on the quality of care.Head & Neck,31(7),902-910.
16. Ouwens, M. M.,Marres, H. A.,Hermens, R. R.,Hulscher, M. M.,van den Hoogen, F. J.,Grol, R. P.,Wollersheim, H. C.(2007).Quality of integrated care for patients with head and neck cancer: Development and measurement of clinical indicators.Head & Neck,29(4),378-386.
17. Ouwens, M.,Hulscher, M.,Hermens, R.,Faber, M.,Marres, H.,Wollersheim, H.,Grol, R.(2009).Implementation of integrated care for patients with cancer: A systematic review of interventions and effects.International Journal for Quality in Health Care,21(2),137-144.
18. Phillips, J. L.,Currow, D. C.(2010).Cancer as a chronic disease.Collegian,17(2),47-50.
19. Shah, J. P.,Gil, Z.(2009).Current concepts in management of oral cancer - surgery.Oral Oncology,45(4-5),394-401.
20. Singer, S. J.,Burgers, J.,Friedberg, M.,Rosenthal, M. B.,Leape, L.,Schneider, E.(2011).Defining and measuring integrated patient care: Promoting the next frontier in health care delivery.Oral Oncology,68(1),112-127.
21. Valentijn, P. P.,Boesveld, I. C.,van der Klauw, D. M.,Ruwaard, D.,Struijs, J. N.,Molema, J. J. W.,Vrijhoef, H. J. M.(2015).Towards a taxonomy for integrated care: A mixedmethods study.International Journal of Integrated Care,15(1),e003.
22. Van Overveld, L.,Braspenning, J.,Hermens, R. P.(2017).Quality indicators of integrated care for patients with head and neck cancer.Clinical Otolaryngology,42(2),322-329.
23. Warnakulasuriya, S.(2010).Living with oral cancer: Epidemiology with particular reference to prevalence and life-style changes that influence survival.Oral Oncology,46(6),407-410.
24. Wollersheim, H.,Faber, M.(2012).Better affordable care: A framework to analyse and improve integrated care delivery.International Journal of Care Pathways,16(4),92-97.
25. 林佳慧、曾雯琦、蔣尚霖、蔣立琦(2012)。以病人為中心照護對臨床的成效。護理雜誌，59(6)，104-110。
26. 賴裕和(1998)。門診接受化學治療病人之症狀困擾及居家護理需求探討。護理研究，6(4)，279-289。

1. 鄧喬鳳、蔡斦暻、張碧華、張瑛瑛、張家慧、徐倩儀、周玉書、沈君哲(2018)。使用社群軟體於口腔癌病人連續性照護之生活品質成效探討。榮總護理，35(3)，222-233。