行動遊戲衛教於提升標靶藥物使用者皮膚自我照護之成效

Abstract

背景：病人服用表皮生長因子受體（Epidermal growth factor receptor; EGFR）標靶藥物時常出現皮膚藥物不良反應（Cutaneous Adverse Drug Reactions，CADR），缺乏皮膚照護知識可能使 CADR 加重，導致癌症患者預後與生活品質惡化。近年來遊戲化電子醫療照護被發現可提升民眾健康促進行為，卻較少研究探討遊戲衛教應用於提升癌症患者皮膚自我照護的效果。 目的：探討行動衛教程式（mobile application，APP）結合遊戲化教學，是否能提升服用 EGFR 標靶藥物病人對 CADR 的自我照護知識、技能與學習動機之成效。 研究方法：採隨機分派雙組前後測設計，2024 年 2 月至 5 月於北部某醫學中心腫瘤醫學部與皮膚部收案。邀請服用 EGFR 標靶藥物之病人，使用研究者設計之APP 進行為期 4 週的介入，實驗組接受遊戲衛教，對照組則僅接受文字衛教。分別在 Day1、Day15 與 Day30 填答結構性問卷，內容包含人口學資料、CADR 知識、學習動機、照護措施遵從性、程式可用性、有趣性與生活品質。 結果：共 82 位服用 EGFR 標靶藥物之患者隨機分派至實驗組與對照組，兩組於Day15 及 Day30 的知識得分均比 Day1 有顯著進步（p< .001），且實驗組得分明顯高於對照組（p< .001）。Day30 時，兩組的照護遵從度皆有顯著進步（p< .001），且實驗組的遵從度優於對照組（p= .037）。兩組生活品質並未隨時間進展有顯著進步，亦無組間差異。實驗組的 APP 使用時長（p= .001）與有趣性評分（p= .008）均明顯高於對照組。患者若能經常使用此遊戲化教學 APP 便有機會提升其 CADR 知識與照護遵從性，而學習動機、遊戲有趣性與系統可用性將影響患者使用 APP 的時長。 結論：皮膚不良反應是 EGFR 標靶藥物使用者需要長期面對的問題，應用行動遊戲 APP 進行患者衛教於本研究被證實是可行的策略，建議可於患者第一次服藥前進行介入，幫助患者提早了解與藥物相關的皮膚不良反應與學習居家自我照護。

Background: Patients taking Epidermal Growth Factor Receptor (EGFR) targeted therapies often experience Cutaneous Adverse Drug Reactions (CADR). A lack of skin care knowledge may exacerbate CADR, leading to a deteriorated prognosis and quality of life in cancer patients. In recent years, gamified digital healthcare has been found to improve public health-promoting behaviors. However, there is limited research on the application of gamified health education to enhance skin self-care among cancer patients. Aim: This study aimed to investigate the efficacy of a mobile application (APP) combined with gamified instruction in enhancing the knowledge, skills, and learning motivation of patients receiving EGFR-targeted therapies in the self-care of CADR. Methods: A randomized two-group pretest-posttest design was employed, with data collection from February to May 2024 in the oncology and dermatology departments of a medical center in northern Taiwan. Patients taking EGFR-targeted therapies were invited to participate in a 4-week intervention using a researcher-designed APP. The experimental group received gamified health education via APP, while the control group received text-based health education via APP. Structured questionnaires were administered on Day 1, Day 15, and Day 30, covering demographic data, CADR knowledge, learning motivation, adherence to care measures, program usability, enjoyment, and quality of life. Results: Eighty-two patients taking EGFR-targeted therapies were randomly assigned to the experimental and control groups. Both groups showed significant improvement in knowledge scores on Day 15 and Day 30 compared to Day 1 (p < .001), with the experimental group scoring significantly higher than the control group (p < .001). On Day 30, both groups demonstrated significant improvement in adherence to self-care measures (p < .001), with the experimental group outperforming the control group (p = .037). There was no significant improvement in quality of life for either group nor was there a difference between groups. The experimental group had significantly higher APP usage time (p = .001) and enjoyment ratings (p = .008) than the control group. Frequent use of this gamified instructional APP has the potential to enhance CADR knowledge and adherence to care measures. Learning motivation, enjoyment, and system usability will influence patients' duration of app usage. Conclusions: CADRs are a long-term issue for users of EGFR-targeted therapies. This study confirms that using a mobile gamified APP for patient education is feasible. It is recommended to implement this intervention before the patient's first use of EGFRtargeted drugs to help them understand drug-related skin adverse reactions and learn self-care at home.