急性骨髓性白血病病人症狀困擾與照護需求之探討

Exploration of the Symptom Distress and Care Needs with Acute Myeloid Leukemia Patients

背景：症狀困擾及照護需求相關概念是照護病人的重要依據，目前國內缺乏此類相關性研究。目的：瞭解急性骨髓性白血病病人於化學治療期間症狀困擾與照護需求之變化，並探討人口學因子對其預測狀況。方法：採縱貫式前瞻性研究設計，方便取樣，以結構式問卷分別於病人接受化學治療當日、治療後第7天、第14天及第21天進行病人追蹤資料收集及分析。結果：37位病人參與研究，結果顯示：（1）病人症狀困擾程度以治療後第7天平均40.1分最高，治療後21天下降至平均36.4分最低；（2）各時間點病人自覺症狀困擾以睡不好、沒有胃口、疲倦感為主；（3）病人於化學治療當日測得的照護需求以健康系統與資訊需求最高，治療後第7天、第14天及第21天則以病人照護與支持需求最高；（4）病人症狀困擾變化狀況受到疾病狀況的影響，無疾病緩解病人於治療後第7天的症狀困擾嚴重程度增加量高於有疾病緩解病人，達統計上顯著差異；（5）病人照護需求變化狀況受到年齡、教育程度、工作狀況、婚姻狀況及宗教信仰之影響，其中年齡≧50歲、國中以下、有工作、已婚的病人於治療後第7天的照護需求增加量高於＜50歲病人、高中以上、無工作、未婚的病人，另外，有宗教信仰者於治療後第7天、第14天、第21天的照護需求增加量亦高於無宗教信仰者，以上改變量皆達統計上顯著差異。結論／實務應用：針對上述發現，建議醫療人員除於化學治療前及過程中提供更積極的睡眠、進食及疲憊症狀預防處置及照護措施，並考量病人照護需求變化趨勢及人口學因子對於病人症狀困擾及照護需求變化之影響，適時適切滿足病人照護與支持。 Background: The distressing symptoms and care needs among patients with acute myeloid leukemia receiving induction chemotherapy are important but rarely explored in Taiwan. Purpose: This study focused on the severity and changes in distressing symptoms and care needs of patients with newly diagnosed acute myeloid leukemia underwent induction chemotherapy and investigated the relevant predictive demographic factors. Methods: This was a longitudinal prospective study using convenience sampling and structured questionnaires to collect data in acute myeloid leukemia patient at day 0 and day 7, day 14, and day 24 post induction chemotherapy. Results: A total of 37 patients participated, and results showed that: (1) the severity of distressing symptoms was highest at day 7 (mean score 40.1) and lowest at day 21 (mean score 36.4) after chemotherapy. (2) the first three most common distressing symptoms across all study time points were poor sleep, lack of appetite, and sense of fatigue. (3) patients' need for health system and medical information was the highest at day 0, while the need for supportive care was the highest at day 7, day 14, and day 21 after chemotherapy. (4) the increase in the severity of distress between the date of chemotherapy and day 7 after chemotherapy for patients without disease remission was higher than that of those with disease remission, and the difference reached statistical significance. (5) this study discovered that the change in patients' care needs was significantly affected by age, educational level, working condition, marital status, and religious belief. From the date of chemotherapy to day 7 after the chemotherapy, the increase in the care needs of patients ≥50 years old, educational background is junior high school and under, employed, married was higher. Moreover, from the date of chemotherapy to day 7, day 14, and day 21 after the treatment, the increase in the care needs of patients with a religious belief was higher than that of those without one. The changes above all reached statistical significance. Conclusions/Implications for practice: According to our results, medical personnel should vigorously provide appropriate care to relieve both physical and emotional distress during the course of induction chemotherapy; moreover, it is advised to take into account the demographic factors to satisfy patients' needs for care and support in a timely and appropriate manner.