成人癌因性疲憊非藥物處置之臨床照護指引

Clinical Guidelines for Management of Nonpharmacological Cancer-Related Fatigue in Adult Patients

10.6142/VGHN.202206_39(2).0001

洪世欣(Shih-Hsin Hung)；郭鳳霞(Foung-Shia Kou)；樊君儀(Chun-I Fan)；詹明珊(Ming-Shan Jan)；劉曉君(Hsiao-Chun Liu)；莊紫雲(Tzu-Yun Chuang)

癌因性疲憊 ； 臨床照護指引 ； 非藥物處置 ； cancer-related fatigue ； clinical care guideline ； nonpharmacological management

榮總護理

39卷2期（2022 / 06 / 01）

112 - 134

繁體中文

癌因性疲憊（Cancer-related fatigue, CRF）是癌症病人高盛行率的症狀困擾，會影響癌症病人的治療遵從性及存活率，故癌因性疲憊之照護已成為近年來癌症照護之重要議題。本指引建構分四階段進行，第一階段進行系統性文獻搜尋、評析與精萃，共納入33篇實證等級Level I的系統性文獻回顧，及6篇Grade A的臨床照護指引；第二階段以專家焦點團體座談進行指引草案之效度檢定；第三階段是依專家意見修正照護指引初稿；第四階段是發展問卷，調查臨床專家及照護人員對照護指引之可行性意見後建立臨床照護指引。本指引內容涵蓋四構面，構面一：強化病人對癌因性疲憊症的知能（3項）；構面二：增進醫療團隊成員之教育訓練與整合性評估能力（6項）；構面三：癌因性疲憊症之因應策略（23項），含能量保存、運動、認知行為治療、心理社會支持、睡眠衛生、營養、輔助療法；構面四：轉介跨領域專家（2項），共計34項。其中29項建議強度A、5項建議強度B。指引內容經由三位實證專家以AGREE II評析並提供建議，藉此研究法縝密建構本土化高等級之臨床照護指引，供國內醫護人員臨床照護之最佳證據，提升癌症病人因應疲憊照護之能力，進而提高病人癌症治療之遵從性及生活品質。

Cancer-related fatigue (CRF) is highly prevalent and affects the compliance with treatment and survival rate of patients with cancer. Caring for patients with CRF is crucial. This study developed clinical guidelines in four phases. The first phase involved a systematic literature review and distillation of 33 articles with Level I evidence and 6 Grade A clinical care guidelines. In the second phase, expert focus group discussions were held to validate the drafted guidelines. In the third phase, the first draft of the guidelines was revised on the basis of the experts' opinions. In the fourth phase, questionnaires were developed to survey clinical experts and nurses regarding the feasibility of the guidelines, which were then revised. These guidelines cover four aspects, one of which relates to improving patients' knowledge of CRF (three items) and another relates to improving education, training, and integrated assessments for health-care teams (six items). The third aspect relates to strategies to treat CRF (23 items), namely energy conservation, exercise, cognitive–behavioral therapy, psychosocial support, improving sleep hygiene, nutrition, and complementary therapy. The fourth aspect relates to referral to experts in several fields (two items); the guidelines comprise a total of 34 items. A total of 29 recommendations were proposed for Grade A and 5 for Grade B. Three experts were invited to evaluate the guidelines by using AGREE II and to provide suggestions. This study established the guidelines to provide a reference for clinical care in Taiwan, to help patients with cancer cope with fatigue care, to ensure patient compliance with treatment, and to improve patients' quality of life.

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