協助一位肺腺癌病人全家達成治療決策共識之個案管理經驗

Nursing Experience of Case Managment in Helping a Patient with Pulmonary Adenocarcinoma to Reach Family Consensus of Therapy

10.3966/168395442016121602006

廖翊竹(Yi-Chu Liao)；許麗玉(Li-Yu Hsu)；施美玲(Mei-Ling Shih)；謝秀芳(Hsiu-Fang Hsieh)

肺腺癌 ； 藥品可近性 ； 治療決策衝突 ； 生活照顧需求 ； 個案管理 ； Pulmonary Adenocarcinoma ； Access to Medicines ； Conflicts in Treatment Decision-Making ； Needs of Daily Care ； Case Management

腫瘤護理雜誌

16卷2期（2016 / 12 / 01）

59 - 72

繁體中文

本文係為照顧一位肺腺癌合併腦轉移之中年女性，藉由個案管理照護措施之介入，成功協助個案解決家人間對於治療決策之衝突，進而達成全家共識之個案管理經驗。護理期間自2013年7月4日至2014年9月20日，藉由觀察、身體評估、家庭討論會與查閱病歷紀錄等方式收集資料，以生理、心理、靈性、社會等層面的評估，確立個案有自我照顧能力缺失、治療決策衝突、疼痛、跌倒、排泄型態障礙、無力感等六項健康問題。因治療此疾病之標靶藥物所費不貲，致使家屬間因經濟困難而對治療產生歧見；此外，隨著疾病的進展，個案日常照顧需求與日俱增，造成照顧者的負擔加重，故筆者以治療決策衝突及自我照顧能力缺失等二個關鍵問題進行探討。筆者提供個案以病人為中心之照護模式，依其需求同時扮演照護者、教育者、管理者、協調者等角色功能，並透過團隊合作，促使個案與家人間達成決策共識，更增進彼此的感情與凝聚，家屬能在整個癌症治療期間及臨終末期階段，陪伴個案共同渡過。腫瘤個案管理護理師在今日照護環境中，應秉持終身學習精神，結合各醫療團隊合作，適時協助病人及家屬解決醫療上的問題，以發揮獨特的功能，期本文能提供腫瘤個案管理護理師日後照護類似個案之參考。

This case report describes the nursing experience in case mangement of a middle-age female patient who suffered from adenocarcinoma of the lung with brain metastases. The nursing period was from July 4th, 2013 to September 20th, 2014. The case management nurse facilitated in conflicts resolution of treatment decision in order to reach family consensus for the patient to receive expensive target therapy in time. Data were collected through direct interactions with the patient and her family, physical examination, family meetings, and medical records. A total of 6 health problems were identified through physical, psychological, social, and spiritual assessments during the nursing process. Playing the role of resource and service coordinator, case manager, patient/family educator, and clinical care provider, the case management nurse discussed patient‘s declining selfcare functioning and confliting positions of family members in treatment decision. Using patient-centered care, conflicts in treatment decisions among the patient and her family members were resolved via decision guidance and coaching. With the power of teamwork, the costly targeted therapy was made affordable after the integration of financial resources from both inside and outside the family. In the process, family consensus on the treatment was reached and family cohesiveness strengthened. As a result, the family could provide care and support what the patient needed at different stages of disease including the final days. In today’s healthcare community with advanced medicine, case management nurses need to have not only expertise in caring for cancer patients from lifelong learning for evidencebased practice, but also the capability to overcome barriers to access treatments. We hope this case report provides practical suggestions that nurses can apply in their daily practice to improve their care quality and to ensure timely treatment.

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