口腔照護管理行動應用程式介入對頭頸癌病人照護成效之前驅研究

智能手機具備多功能特性，已與健康照護結合為行動健康照護(mHealth)，運用於病人照護有助於改善照護品質。目的:探討口腔照護管理行動應用程式介入對頭頸癌病人照護之成效。方法:採類實驗設計，以立意取樣選取北區某區域醫院之同步接受化學與放射線療法的頭頸癌病人為研究對象，收案期間自107年7月至108年3月止，共收32位研究個案，分別各分派16位控制組(常規照護)，介入組(口腔照護APP)。研究工具分別為口腔黏膜炎分級(NCI CTCAE ver. 3.0)、疼痛量表(NRS)、心情健康量表(BSRS-5)、病人主觀整體評估(PG-SGA)、生活品質量表(EORTC QLQ-C30和EORTC QLQ-H&N 35)、使用者介面滿意度(UQIS)與認知負荷量表(NASA-TLX)，進行資料收集。使用SPSS 21.0軟件以描述性統計分析平均數、標準差，獨立樣本 t 檢定，廣義估計方程式，皮爾森積差相關等進行資料分析。結果: 介入組與控制組的基本屬性、口腔癌程度、癌症分級在介入前均無差異(p> 0.05)。介入組的口腔黏膜炎等級於治療第二個月低於控制組(P=0.003)，GEE分析，介入組比控制組在治療第二週、第一個月、第二個月，口腔黏膜炎等級減少皆達顯著差異(p< 0.05)；口腔疼痛、情緒困擾、營養指數在治療第二個月相較於控制組減緩，皆顯著差異(p< 0.05)；介入組的生活品質高於控制組(P=0.001)，GEE分析結果，QLQ-C30的生活品質與情緒功能相較於控制組佳、疼痛症狀較減緩，皆顯著差異(p< 0.05)，QLQ-H&N35的疼痛問題、吞嚥問題、張嘴問題、唾液黏稠、病態感、使用鼻胃管等症狀相較於控制組減緩，皆顯著差異(p< 0.05)；使用者在操作APP口腔照護的整體性滿意度趨向為滿意(4.14±0.09)，對操作APP的認知負荷趨向於低負荷壓力(1.56±0.66)。結論與臨床應用: 因近年來智能手機使用的普及性與方便性，行動醫療照護已運用於臨床實務照護，病人運用“口腔照護APP”行動照護工具，可依照目前口腔黏膜炎分級變化，及早執行口腔照護與自我症狀管理，能改善病人口腔炎的疼痛與嚴重程度，提升生活品質。

Smartphones have multiple functions and have been combined with healthcare for mobile healthcare (mHealth), which has been used in patient care to improve care quality.Purpose: To investigate the effectiveness of oral care management APP for patients with head and neck cancer.Method: This study used quasi-experimental design and purposive sampling to enroll a total of 32 patients with head and neck cancer concurrently receiving chemotherapy and radiotherapy in a certain regional hospital in the northern Taiwan as the research subjects from July 2018 to March 2019. 16 subjects were randomized to the control group (conventional care) and intervention group (oral care APP), respectively.The measurement tools including oral mucositis classification of National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE ver. 3.0), pain scale (Numeric Rating Scale, NRS), mental health scale (Brief Symptom Rating Scale-5, BSRS-5), Patient-Generated Subjective Global Assessment (PG-SGA), quality of life scales (EORTC QLQ-C30 and EORTC QLQ-H&N 35), Questionnaire for User Interface Satisfaction. (QUIS) and cognitive load scale (NASA-TLX).The data were analyzed by descriptive statistics, including mean, standard deviation, independent sample t test, Generalized Estimating Equation, Pearson''s correlation using SPSS 21.0 software.Results: There was on significant difference in demographic variables, oral mucositis and cancer classification between control group and intervention group before intervention. The oral mucositis severity of the intervention group at Month 2 the treatment was lower than that of the control group (P=0.003). Gee analysis showed, compared to the control group, the oral mucositis severity of the intervention group at Week 2, Month 1 and Month 2 the treatment decreased, respectively reaching the significant differences (p< 0.05). Compared to the control group, the oral pain, emotional distress, and nutrition index of the invention group at Month 2 the treatment all were alleviated, reaching the significant differences (p< 0.05). The quality of life of the intervention group (P=0.001) was higher than that of the control group. Besides, Gee analysis showed, the quality of life and emotional functions of the intervention group in the QLQ-C30 were better than those of the control group, and the pain symptoms were alleviated. All of the above reached the significant differences (p< 0.05). Compared to the control group, the symptoms, such as pain issue, swallowing issue, mouth opening issue, thick saliva, sense of morbidity, and use of nasogastric tube, in the QLQ-H&N35 of the intervention group were alleviated, and all reached the significant differences (p< 0.05). The overall satisfaction of users operating the oral care APP was “Satisfied” (4.14±0.09), and their cognitive load of operating the APP was low load and pressure (1.56±0.66). Conclusions and Clinical Applications: In recent years, owing to the popularity and convenience of use of smartphones, mobile healthcare has been apply in practical clinical care. Patients using “oral care APP” can implement oral care and self-management of symptoms early according the classification of oral mucositis severity to improve their discomfort and enhance quality of life.