預防腫瘤高血鈣症衛生教育成效之初探

A Preliminary Study of the Prevention Education Program Effectse on Malignancy Hypercalcemia

鑑於癌症高血鈣是臨床常見，且高血鈣危症可能帶來致命的危險，本研究目的為測試一自製預防高血鈣同步幻燈視聽教材之衛生指導之成效。預防高血鈣症同步幻燈視聽教材，為以健康信念模式為主軸所建立的18張幻燈同步視聽教材，以團體及個別方式進行衛生指導。研究採單組前後測之前實驗設計。於民國87年5月至87年8月，由某血液腫瘤病房入院病患中，收案29位病患，給予預防高血鈣症衛生指導，並進行衛生指導前後的比較，包括高血鈣知識量表、預防高血鈣行為評估表、及高血鈣症狀評估表以測試衛教的成效。高血鈣知識量表於收案時實施前測，於衛生指導四天後或出院前實施後測。預防高血鈣行為、高血鈣症狀，則於收案時作初步評估，並於其後每月追蹤，共連續三個月。結果顯示：29位腫瘤病患其預防高血鈣知識，由衛教實施前的6.3±4.6答對題分，增至衛教後的13.6±3.1題分，以Wilcoxon符號排序檢定達p<0.05顯著差異。追蹤三個月期間，7患者死於敗血症及腎衰竭，其餘22患者的自我照顧能力明顯變差(p<0.05)。預防高血鈣行為，以Wilcoxon符號排序檢定，足夠水份攝取、避免高鈣飲食、改變體位姿勢，在追縱的三個月間均達p<0.05顯著差異，顯示同步幻燈視聽教材所提供的衛生指導的成效及推廣性。22病患的血鈣值，在三個月追蹤期間均無高血鈣症發生，然限於研究設計，未能顯現與衛教之關係。

Malignant hypercalcemia is a common and critical problem for Oncology patients. The impact of the hypercalcemia and its acute onset can belief threatening. A hypercalcemia prevention program, which included 18 slides, was developed according to the Health Belief Model. The education program was provided via either group or individual teaching in a Hematology unit. The education program was conducted by one group, pre-and post-test, pre-experimental study from May 1998 to July 1998. Twenty-nine hospitalized patients were enrolled in the study. The education program was evaluated using hypercalcemia knowledge questionnaire, hypercalcemia prevention activities checklist, and hypercalcemia sign and symptoms checklist. The pre-test for hypercalcemia knowledge was conducted before the health education, with the post-test conducted 4 days later or before the discharge. Prevention activities, serum calcium level, and hypercalcemia symptoms were evaluated before the education program and followed-up monthly for 3 months. The result showed that the mean score for the hypercalcemia knowledge changed significantly from 6.3±4.6 before the education to 13.6±3.1 after the education according to the Wilcoxon signed Rank Test (p<0.05). Within the 3-month following-up, seven patients died of sepsis and renal failure while other 22 patients' daily living activities were getting worse significantly via Wilcoxon signed Rank Test (p<0.05). Preventing activities, which included taking adequate fluid, avoiding high calcium diet, and corrected positioning changed significantly via Wilcoxon Signed Rank Test (p<0.05). The study showed marked progresses in understanding hypercalcemia and taking the prevention behaviors after this education program. No hypercalemia was found for all 22 subjects within the 3-month follow-up. No conclusion can be made about the relation between the prevention education and hypercalcemia because of the limited study design. In General, the study suggests emphasizing and extending the hypercalcemia prevention program not only for Hematology patients but also for all Oncology patients.