| Summary: | 碩士 === 長庚大學 === 護理學研究所 === 97 === Pain is the most common symptom of cancer patients, causing approximate 80% patients in a need of narcotics for pain control. Among these narcotics, morphine is the treatment of choice for severe cancer-related pain. However, the use of morphine usually accompanies with many adverse effects, including the most common one, constipation. Morphine-induced constipation (MIC) develops in 25 – 50% patients receiving morphine and attenuates their quality of life (QOL). Our preliminary study demonstrated that abdominal ice packing (AIP) could adjust bowel movement in normal subjects. The present study aimed to evaluate the effect of AIP on MIC in terms of severity of constipation-related symptoms, bowel movement, anxiety, depression and QOL.
End-stage cancer patients with MIC under hospice care were enrolled and randomized to control (receiving routine nursing care) and experimental (receiving routine nursing care plus AIP) groups. Twenty nine patients performed pre-test at day 1 and fifteen patients completed all the assays. All the end points between two groups were compared upon the basis of homogeneity in characteristics of subjects. The severity of constipation-related symptoms assessed by Patient Assessment of Constipation Symptoms (PAC-SYM) in experimental group was less than the controls (p =.000). Measurement of bowel movement by using stethoscope showed a marked increase, up to 87% increment, in experimental group (p =.039 ). Performance of AIP improved the state of anxiety (p =.010), but not depression (p =.153) via assessment with The Hospital Anxiety and Depression Scale (HADS). Furthermore, through the use of Patient Assessment of Constipation Quality of Life (PAC-QOL), we found that AIP significantly improved the QOL of these MIC patients in terms of total score (p =.002), physical discomfort (p =.001), psychosocial discomfort (p =.004), worries and concerns (p =.026), as well as satisfaction (p =.038).
In conclusion, AIP, a non-invasive nursing management, could improve the severity of constipation-related symptoms, bowel movement, anxiety and QOL in end-stage cancer patients with MIC during hospice care.
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