多專科整合團隊於頭頸癌之照護

cgust 2021-11-292021-12-14

長庚科技大學護理系暨護理研究所陳淑卿教授

多專科整合團隊(multidisciplinary team care, MDTC)是健康照護人員之間的合作，提供以病人為中心的治療及照護(Rosell et al., 2018; Taplin et al., 2015)，可以發展理想的治療計畫(Badran et al., 2018)、促進治療遵從性(Chang et al., 2020; Rosell et al., 2018)、強化治療後的生活品質(Stephens et al., 2006)及延長存活(Forrest et al., 2005)。

團隊特色

頭頸癌多專科整合團隊特色，包括: (1) 發展各別性的治療計畫: 根據影像學檢查及治療指引(Lin et al., 2020)，(2)共享決策: 病人、照顧者、主治醫師及個案管理師共同討論治療計畫，(3)個案管理: 個案管理師溝通協調手術、重症照護、營養諮詢、復健及情緒支持，(4)篩選中斷治療的高危險個案: 早期發現中斷治療的高危險個案，包括: 共病、合併症、住院天數長、低社經地位及家庭支持薄弱等，(5)發展輔助性化學治療療程 (adjuvant chemotherapy protocols): 根據病理切片報告發展輔助性化療療程包括: 化學治療、放射線治療或同步化學放射治療(Lin et al., 2020)，(6)照護品質的監測與控制: 輔助性化學治療期間監測照護品質，強化病人自我照顧的能力(飲食準備及症狀處置)。

團隊成員

頭頸癌多專科整合團隊涵蓋各專科，包括: 耳鼻喉科醫師、腫瘤科醫師、放射腫瘤科醫師、病理科醫師、放射診斷科醫師、核子醫學科醫師、個案管理師、營養師、物理治療師、職能治療師、語言治療師、社工師及護理師。

團隊運作

頭頸癌多專科整合團隊成員每週開會討論，診斷、討論治療意見、發展治療計畫書、變更治療計畫、根據病程或中斷治療修訂治療計畫等，若有緊急狀況、轉移或復發，視需要開會及討論。

頭頸癌多專科整合團隊提供支持性照護，包括: (1) 社會福利: 低社經地為個案提供社會福利資源，經濟資助、復康巴士及支持團體，(2)轉介: 家庭支持薄弱的個案轉介至住家鄰近的醫院持續治療及追蹤，(3)病友支持團體: 頭頸癌病友會的病友之間彼此互相連結、協助、分享類似的經驗，(4)病患志工: 訓練頭頸癌病人擔任志工，探視頭頸癌病人，提供鼓勵、關懷及分享證項治療經驗，(5): 視訊會議: 新冠肺炎爆發期間，採視訊會議頭頸癌多專科整合團隊持續運作。

團隊成果

本團隊分析2016年1月至2018年6月，個案管理師管案資料發現中斷治療率為6.3%，其中1.3%為中斷進行中的治療，5.0%為中斷確診後之治療(Chang et al., 2021)。分析2016年1月至2018年6月，個案管理師管案資料發現拒絕治療率為12.1%(Chang et al., 2020)，低於先前的研究(Choi et al., 2017; Huang et al. 2014; Mehta, Lenzner, & Argiris, 2012; Suh et al., 2017)。

致謝感謝科技部及長庚醫院研究經費的贊助，感謝長庚醫院頭頸癌團隊、質子暨放射治療中心及癌症中心的鼎力協助。

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