| Summary: | 博士 === 國立臺北護理健康大學 === 護理研究所 === 107 === Under the increased amount of cancer survivors which promoted by early screening and evolution of treatment, load of national health expenditure rapidly increased which made focus on prevention, treatment and care of cancer. Colorectal cancer is the third most common cancer in terms of incidence worldwide and the most common one in Taiwan. Nevertheless, rectal cancer patients with anterior resection syndrome are a subgroup of colorectal cancer population who experienced the most miserable impaction on daily life. Thus, promotion of qualified care in the subgroup can improved whole quality of colorectal cancer patients’ care grandly and effectively.
Based on result of systematic review, service background and the past experience of conducting qualitative study, the researcher found out major clinic dilemma, made sure research topic and constructed a theory for explaining varied clinic phenomenons by research process of constructivist grounded theory. The research process included: depending on the disciplinary focus to promote theoretical sensitivity; asking pivotal research questions; conducting initial data collection based on the questions; keeping on the alternative conduction of constant comparison analysis, self-reflection, theoretical sampling and collection of data; and repeating comparison and analysis between new and old data through by alterative usage of initial coding, focus coding, axial coding and theoretical coding before theoretical saturation. Eventually, “A substantive theory of self-healthcare for rectal cancer patients with anterior resection syndrome” was constructed.
The researcher invited 19 of rectal adenocarcinoma patients who receiving anal preservation surgery with or without closure of stoma, 11 of families who lived with the population and 10 of healthcare team members who care the patients to participate the process. The conducted substantive theory relied on the core category, “Journey of Seeking Re-Control”, to link all of the theoretical categories, including anterior resection syndrome, distress of anterior resection syndrome, motivation of seeking management, strategies of dynamic self-adjustment management, status of family support, influencing factors of medical assistance and healthcare team, which was used to explain the process of building up strategies for managing the altered bowel function under the interactions between patients, families and health care team members.
The theory can provide a strong evidence base for application in clinic practices. According to the results of anterior resection syndrome and its distress, clinic specialists can comprehensively evaluate patients’ symptom distress. Depended on the ones in motivation of seeking management, the goal of patients’ appointments can be predicted. Relied on the one in strategies of dynamic self-adjustment management, healthcare team members can make sense of the points for effective education and use it to set the content of patients’ education. According to the results on status of family support, influencing factors of medical assistance and role function of healthcare team members, clinic healthcare team can make sure the adequacy of patients’ support systems.
Hope “the substantive theory of self-healthcare for rectal cancer patients with anterior resection syndrome” can provide a theoretical cornerstone to enhance quality of care. Furthermore, it can reach the major goal of providing qualified care in the institutions.
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