飲食衛教方案對口腔癌術後病人營養狀況與生活品質之成效

The Effects of a Diet Education Program on Nutritional Status and Quality of Life in Oral Cancer Patients Who Underwent Surgery

背景：一般口腔癌治療以手術為主，導致口腔或顏面結構缺損衝擊病人的吞嚥或咀嚼能力，常造成病人營養狀況和生活品質影響。目的：了解口腔癌術後病人營養狀況與生活品質及檢視飲食衛教方案對口腔癌術後病人營養狀況與生活品質之成效。方法：採類實驗設計，手術後可經口喝水時即收案，採隨機分派為實驗組42人與對照組42人。兩組病人均提供吞嚥運動指導及進行一次前測和三次後測共追蹤三個月，實驗組提供飲食評估和飲食衛教方案介入。測量工具為護理營養篩檢表及口腔健康衝擊量表。結果：有營養不良風險者（前測vs.3個月後測），實驗組47.6％ vs. 4.8％，對照組35.7％ vs. 42.9％。經廣義估計方程模式顯示，接受飲食衛教方案介入病人營養狀況與生活品質改善成效皆優於對照組（p＜.001）。結論／實務應用：飲食衛教方案可有效改善口腔癌病人術後營養狀況與生活品質，建議於口腔癌治療期間宜提供特製化營養支持，協助維持良好的營養狀態，以提升生活品質。

Background: Surgery, the primary treatment for oral cancer, results in oral and facial structural defects that may cause difficulties in swallowing or mastication and thereby affect nutrition status and quality of life. Purpose: This study was designed to understand nutritional status and quality of life in oral cancer patients who had undergone surgery and to examine the effects of a dietary education program on nutritional status and quality of life in these patients. Methods: A quasi-experimental design was conducted. Eligible patients were enrolled immediately after they could sip water after surgery. The participants were randomized into the experimental group (n = 42) and the control group (n = 42). Both groups were provided guidance for swallowing exercise and performed a pre-test (T0) and three posttests (T1-T3) for a total of three months. The experimental group additionally received a diet assessment and dietary education program intervention. The outcome measures included the nursing nutritional risk screening tool (NNRST) and oral health impact profile (OHIP-14T). Results: The level of malnutrition risk (T0 vs. T3) was 47.6% vs. 4.8% in the experimental group and 35.7% vs. 42.9 in the control group. Generalized estimating equation (GEE) statistics were used to assess the effects of the dietary education program on nutritional status. Quality of life was found to be significantly better in the experimental group than in the control group (p < .001). Conclusions/Implications for Practice: A dietary education program may be used to effectively improve the nutritional status and quality of life of patients after oral cancer surgery. We suggest that specialized nutritional support be provided during cancer treatment in order to achieve good nutritional status and improve quality of life.