運用疲倦照護指引於臨床照護－－以成人白血病個案為例

Applying Fatigue Practice Guidelines in Clinical Care: Examples of Adult Leukemia Patients

癌症相關疲倦是癌症患者最常經歷的症狀，對於住院接受高劑量化學治療的白血病患者而言，其疲倦程度更為明顯；因此住院期間疲倦護理的需求也相對比其他固態腫瘤（solid tumor）患者高。雖然美國國家癌症資訊網（The National Comprehensive Cancer Network, NCCN）已針對癌症相關疲倦提出完善的照護指引，然而台灣大多數的臨床照護者並不熟悉其使用方式及時機，且評估的內容項目完整而多層面，導致疲倦照護指引在台灣臨床上使用不易。因此，本文介紹2011年NCCN疲倦照護指引之內容（包括評估疲倦型態、疲倦程度及可能導因，根據不同疲倦程度的患者給予適當的指導及處置），同時運用指引於不同疲倦程度的成人白血病病患，說明如何運用照護指引於臨床照護，期望藉此實際運用指引於臨床個案之討論，協助臨床照護者瞭解如何善用照護指引，以提供患者更完善的疲倦照護。

Cancer-related fatigue is one of the most prevalent symptoms experienced by cancer patients. The high-dose chemotherapy regimen given to those with hematological malignancies makes this group in particularly urgent need of fatigue management during hospitalization. The National Comprehensive Cancer Network (NCCN) has published practice guidelines for cancer-related fatigue. However, the complexity of these guidelines has prevented their widespread application in Taiwan. Most healthcare providers remain uncertain as to how and when to assess fatigue. This article summarizes 2011 NCCN fatigue practice guidelines, including those related to assessing fatigue patterns, intensity, and causes and choosing appropriate interventions based on patient fatigue level. The authors further share their experiences using the guideline in caring for adult hematological patients with different fatigue levels. Through these examples, we hope healthcare providers will properly apply practice guidelines and provide better care to patients experiencing fatigue.