一位胃癌合併腹膜轉移病人首次化學治療之照護經驗

Caring for a Patient with Gastric Cancer and Peritoneal Metastasis Undergoing the First Round of Chemotherapy

10.6880/TJON.202012/SP_20.04

賴威廷(Wei-Ting Lai)；蔡宜蓁(Yi-Tseng Tsai)

胃癌 ； 腹膜轉移 ； 化學治療 ； gastric cancer ； peritoneal metastasis ； chemotherapy

腫瘤護理雜誌

20卷增訂刊（2020 / 12 / 01）

99 - 112

繁體中文

本文敘述一位胃癌合併腹膜轉移首次接受化學治療病人，護理期間自2018年6月8日至6月30日，經由會談、身體評估、觀察及直接照護等方式收集資料，運用Gordon十一項健康功能型態評估進行整體性評估及資料整合分析歸納，確立個案有營養少於身體需要、焦慮及無望感等健康問題。護理過程依個別性及喜好擬定營養計畫及監測飲食攝取量，維持基本身體代謝需求及提高免疫功能；醫療團隊運用醫病共享決策，瞭解個案內心感受及澄清其疑慮，使其減輕對化學治療的不安恐慌，進而降低焦慮不安情緒；透過良好的護病關係，協助其疾病適應及增強正向信念，降低罹癌衍生的無望感。建議醫療團隊除了緩解病人生理不適症狀外，更需重視病人身心需求及想法，早期介入處理個案的負向情緒反應，接受並同理焦慮不安感受，以正向心態面對疾病不可逆之事實，方可及早適應疾病及生活改變，以達身、心安適狀態，期望經此照護經驗分享，以供臨床實務參考之用。

This article describes the experience of nursing a patient with gastric cancer and peritoneal metastasis who was undergoing chemotherapy for the first time. The nursing care was performed during June 8-30, 2018. Data were collected through meetings, physiological assessments, observations, and direct care. The Gordon 11 Function Health Patterns was used for the overall assessment and data compilation, analysis, and deduction. The patient was confirmed to have the health problems of poor nutrition, anxiety, and a sense of hopelessness. During the nursing process, nutrition plans were personalized according to the patient's preferences and dietary intake was monitored to sustain the basic metabolic demand and boost the immune system. The medical team practiced shared decision-making between the patient and the team to understand the patient's feelings and to alleviate the doubts the patient had to reduce uneasiness and panic regarding chemotherapy, thereby reducing anxiety and feelings of uneasiness. By developing a strong nurse-patient relationship, the author assisted the patient in coping better with the disease and intensified the positive beliefs, thus reducing the sense of hopelessness the patient felt in relation to cancer. Author also suggested that medical teams not only alleviate patients' physiological discomfort but also heed their psychological needs and thoughts. Early intervention of patients' negative emotional responses, accepting and empathizing with patients' feelings of anxiety and uneasiness, and fostering patients' positive attitudes toward the irreversibility of the disease can help them coexist with the disease at an earlier time. Moreover, this will help patients to make subsequent life changes to achieve a state of physiological and psychological comfort. Author hopes that this nursing experience can serve as a reference for future clinical practices.

1. 吳詩萍, S. P.,許雅娟, Y. C.(2016)。初次接受化學治療之癌症老年病人之因應行為與症狀困擾相關性之探討。護理雜誌，63(6)，30-40。
   連結：
2. 葉依婷, Y. T.,林亞卿, Y. T.,葉昱辰, Y. C.,郭素青, S. C.,鍾玉珠, Y. C.(2016)。運用安寧療護於一位胃癌末期病人的護理經驗。彰化護理，20(1)，61-71。
   連結：
3. Correa, P.(2013).Gastric cancer: overview. Gastro-enterology.Clinics of North America,42(2),211-217.
4. Gilbar, P.(2019).Shared decision making can aid the informed consent process for end-of-life chemotherapy in cancer patients.Journal of Oncology Pharmacy Practice,25(1),249-250.
5. National Cancer Insitute (2018, December). General information about gastric cancer. Retrieved from https://www.cancer.gov/types/stomach/patient/stomach-treatment-pdq
6. Piazuelo, M. B.,Correa, P.(2013).Gastric Cáncer: Overview.Colombi-a Médica (Cali),44(3),192-201.
7. Senf, B.,Brandt, H.,Dignass, A.,Kleinschmidt, R.,Kaiser, J.(2010).Psychosocial distress in acute cancer patients assessed with an expert rating scale.Supportive Care in Cancer,18(8),957-965.
8. World Health Organization (2018, September). Can-cer. Retrieved from https://www.who.int/en/news-room/fact-sheets/detail/cancer
9. 台灣癌症臨床研究組織（2012年1月）．胃癌臨床診療指引．取自http://www.nhri.org.twNHRI_ADM/userfiles/file/tcog/101gastricpgpdf [Taiwan Cooperative Oncology Group. (2012, January). Guidelines for clinical diag-nosis and treatment of gastric cancer. Taipei City Medical Journal, Retrieved from http://www.nhri.org.tw/NHRI_ADM/userfiles/file/tcog/101gastricpgpdf]
10. 江詩雯, S. W.,謝茂志, M. C.,金美雲, M. Y.(2011)。胃癌合併腹腔轉移病人之營養照顧。臺灣膳食營養學雜誌，3(1)，59-64。
11. 李貞慧, C. H.,林宜芬, Y. F.,金惠民, H. M.(2015)。癌末病人安寧療護之營養照護。北市醫學雜誌，12，27-34。
12. 張雅欣, W. H.,董依真, W. C(2016)。運用關懷及安寧療護理念於胃癌末期病人之護理經驗。澄清醫護管理雜誌，12(4)，54-63。
13. 梁品, P.,胡祥, X(2017)。胃癌腹膜轉移的診治策略。中華胃腸外科雜誌，20(5)，500-503。
14. 陳淑琪, S. C.,辛幼玫, Y. M.,何幸美, H. M.(2018)。一位肺癌轉移胃癌瀕死病人之照顧經驗。高雄護理雜誌，35(3)，130-141。
15. 趙毅, Y.(2018)。胃癌好發於亞洲人，而且好發部位與歐美有別。健康世界，498，64-65。
16. 劉燕玲, W. L.,李彩緣, C. Y.(2015)。運用安寧療護理念於胃癌末期病人之照護經驗。安泰醫護雜誌，21(1)，53-63。
17. 衛生福利部統計處（2018年11月）．106年國人死因結果摘要表．取自https://dep.mohw.gov.tw/DOS/lp-3960-113.html。[Ministry of health and Welfare. (2018, November). 106 years of the Republic of China analysis of the cause of death. Retrieved from https://dep.mohw.gov.tw/DOS/lp-3960-113.html]
18. 蘇彥豪, Y. H.(2014)。胃癌的防治。聲洋防癌之聲，144，2-7。
19. 蘇郁捷, W. C.,酈欽菁, C. C.(2015)。運用Watson關懷理論照顧一位胃癌末期病人的護理經驗。馬偕護理雜誌，9(2)，76-89。