系統性護理指導對卵巢癌婦女接受化學治療之認知及症狀困擾之影響

Abstract

卵巢癌（ovarian cancer）是婦女癌症中死亡率最高的癌症，也是最不容易做早期診斷的癌症，約70%的病人在發現時已屬於晚期，其治療除了手術外必須合併多次化學治療。而化學治療卻常引起病人身心不適之副作用，此時期需要護理人員的協助來增加自我照顧能力以減輕化學治療不適症狀及渡過治療過程｡本研究的目的為探討系統性護理指導對病人之治療認知與症狀困擾之影響。 本研究採類實驗法，同組前後測之研究設計方法，於2008年9月至2009年2月在台灣北部某醫學中心收案，收案的對象為卵巢癌Ⅲ期以內接受手術後化學治療或是首次接受化學治療的病患，採立意取樣，共收18名病患。採結構式問卷測量方案成效，包括基本資料表、化學治療之認知、態度及行為問卷、症狀困擾量表。以SPSS/windows13.0統計軟體，依本研究目的及變項性質，選擇適當統計方法進行資料分析。所統計方法含百分比、平均值、標準差、無母數分析法(Nonparametric test)。 本研究之結果：1.卵巢癌病患接受化學治療的認知於首次化療前、病房常規衛教後及系統性護理指導後，三個階段的認知程度皆有差異。2. 系統性護理指導對於卵巢癌病患接受化學治療認知的了解、重要性及執行都有顯著的成效。3.在化學治療認知相關因素中：發現年齡越輕對首次化學治療前的認知程度越好，教育程度越高對於首次化學治療之執行越佳。4.卵巢癌接受首次及第二次化學治療的症狀困擾皆介於無症狀及輕度症狀之間。5.年齡、卵巢癌症的分期及化學藥物的種類對於症狀困擾雖未達統計上的意義，但年齡有負相關的傾向。6.化學治療病人的認知及症狀困擾之間的影響，雖未達統計上意義，但多項有負相關的趨勢，即病人認知程度越好則症狀困擾有減少的傾向。

Introduction: Ovarian cancer has the leading mortality rate for women. It is also the hardest cancer to perform early diagnosis, for example, approximately 70% of all ovarian cancer patients are diagnosed with late stages upon discovery. The treatment for ovarian cancer includes not only surgery, but also multiple courses of chemotherapy. However, chemotherapy often causes severe side effects including biological and psychological events; thus, it is the nursing staffs’ job to assist patients in strengthening their self-attendance abilities to relieve discomfort caused by chemotherapy and to complete treatments. The goal of this research is to explore the influences of systematic nursing instruction on patients’ cognition and symptom coping on treatments. Method: This research adopted quasi- experimental design and was performed a pretest and posttests. 18 patients with the stage I to III ovarian cancer who received chemotherapy for the first time or received chemotherapy post-surgery at a medical center in north Taiwan from September 2008 to February 2009 were enrolled in the study. The performance of this systematic nursing instruction was evaluated by a structural questionnaire including demographics, cognition of the chemotherapy, questionnaire of attitude and behavior and symptom distress scale table. The SPSS/Window13.0 statistical software was used to analyze data and test hypothesis. The main outcome were demonstrated by percentages, means, and standard deviations; as well as, the differences between systematic nursing instruction and usual care/baseline were evaluated by Nonparametric analysis. Results: 1. Patients’ cognition is different among at pre-chemotherapy, usual care and the systematic nursing instruction. 2. The systematic nursing instruction improves patients’ cognitive degree of understanding, importance and execution in receiving chemotherapy. 3. Associated factors in cognition in first chemotherapy are revealed that the younger patients are, the better cognition they have; as well as, the higher education level is, the better the execution is. 4. Symptom distress resulting from first or second chemotherapy for the ovary cancer are nil or mild. 5. Even though there is no statistically significant relation between symptoms distress and age / stage of cancer / category of chemotherapy, there is negative relation to age. 6. There is no statistically significant association between patients’ cognition and symptom distress; however, it is revealed that patients with better cognition have less symptom distress.