建立癌症病人呼吸困難臨床照護指引

Developing Clinical Practice Guidelines for Patients with Cancer-Related Dyspnea

約有50% 至70% 癌症晚期的病人表示有呼吸困難，影響生活品質，本文依照AGREE 臨床指引評估工具之四個階段建置，第一階段訂定指引之適用範圍與目的，及涵蓋的臨床問題；第二階段進行2000-2014 年完整文獻搜尋，經過篩選收納3 篇臨床照護指引、11 篇系統性文獻回顧及其他研究，共評讀39 篇文獻，建立41 項指引草案；第三階段將草案內容製作成問卷，採用德菲法 (Delphimethod) 進行專家共識，修正指引為56 項；第四階段以問卷調查一所醫學中心10位專家及133 位醫護人員實施照護指引之可行性，最後形成51 項指引內容，包含4 構面，綜論6 項、呼吸困難評估11 項、醫療處置24 項（治療病因及藥物治療）、非藥物處置措施10 項；其中建議等級A 級9 項、B 級16 項、C 級3 項、D級23 項。本指引建立可提供醫護人員評估及照護癌症病人呼吸困難之參考，以期增進癌症病人優質照護品質。

Approximately, 50% -70% of patients with cancer have dyspnea, which severely influences their quality of life. In this study, a four-phase design was implemented for developing clinical guidelines to treat such patients. In phase I, the scope and purpose of the guidelines were outlined and clinical questions were addressed. In phase II, a comprehensive systematic review was conducted. Thirty-nine studies published between 2000 and 2014 were evaluated; 3 clinical guidelines, 11 systematic reviews, 12 randomized controlled trials (RCTs), and 13 non-RCTs. Fortyone items were initially included in our clinical guidelines. In phase III, consensus was reached using the Delphi method. In phase IV, a questionnaire was designed for measuring the feasibility of the clinical guidelines. Clinical experts and 133 medical nurses answered the questionnaire, and clinical guidelines comprising 51 items were developed using the feedback obtained. The guidelines were categorized into the following four domains: 6 items of overview, 11 items of dyspnea assessment, 24 items of medical intervention, and 10 items of non-pharmacological intervention. Altogether, 9 Grade A items, 16 Grade B items, 3 Grade C items, and 23 Grade D items were recommended for inclusion in the clinical guidelines. The results provide evidence-based recommendations that can improve the quality of care for patients with cancer-related dyspnea.