遺傳性乳癌的護理

Care of Hereditary Breast Cancer

在台灣，乳癌為女性發生率最高的癌症，其中有部分乳癌患者導因於遺傳基因變異。護理人員首先應完整的收集個案三代至四代的家族疾病史，以評估個案罹癌的風險。護理人員應對個案檢驗前、後的心理社會問題完整評估，運用溝通技巧提供個案充足資訊，提供遺傳諮詢，確保個案在充分知情後決定是否進行BRCA1/BRCA2基因檢驗。當確定個案為帶因者時，護理人員需詳細對帶因者說明後續如何執行密切的監測檢查並強調其重要性。護理人員應提供帶因者瞭解預防性手術與預防性化學治療的預防成效與可能造成的影響，讓帶因者仔細考慮是否執行該項預防性處置。此外，護理人員應以家庭為單位，鼓勵帶因者與家庭成員共同參與遺傳諮詢，協助家庭成員瞭解如何執行預防性監測措施。護理人員應持續加強在遺傳與基因體照護的相關知識與能力，以提升照護品質，期望本文能提供護理人員對於遺傳性乳癌個案與家庭護理之參考。

In Taiwan, breast cancer ranks as the most prevalent form of cancer in the female population. Some breast cancer patients are genetically predisposed to this disease. To assess the risk of hereditary breast cancer for breast cancer patients, nurses should collect client breast cancer family histories back to three to four generations. Nurses should also comprehensively assess client psychosocial problems prior to and after genetic testing, and employ appropriate communications skills to provide clients adequate information regarding the disease. Nurses should ensure that clients are adequately informed prior to deciding whether or not to proceed with BRCA1/BRCA2 testing. When a client is identified as a gene mutation carrier, nurses should explain to her regarding the implementation of a monitoring program and of the importance of long-term follow-up. Nurses should explain to carriers the possible effects and impacts of preventive surgery and preventive chemotherapy so that they may make considered decisions regarding whether and how to implement preventive procedures. Furthermore, nurses should treat client families as a unit, and encourage all family members to participate together in genetic counseling. Nurses should also provide family members with an understanding of preventive strategies. Nurses should improve their knowledge and skills in genomic nursing. We hope this article can provide useful information for nurses to provide care for hereditary breast cancer patients and their families.