背景：化學治療會引發周邊神經病變，特別使用紫杉醇、鉑類與長春花鹼。周邊神經病變症狀，包括麻木、麻刺或燒灼感等，這些症狀影響病人的日常生活活動功能及生活品質，然而，目前仍缺乏化學治療引發周邊神經病變評估指引。
目的：本研究目的為發展「婦癌化學治療引發周邊神經病變評估指引」，以臨床試作評估病人於接受化學治療引發周邊神經病變的症狀，並執行此指引之外部評估，此指引將作為臨床醫護人員，執行化學治療引發周邊神經病變評估之依據。

方法：發展「婦癌化學治療引發周邊神經病變評估指引」流程：（1）選定指引主題並建構臨床問題（PICO）「如何評估婦癌病人周邊神經病變症狀?」；（2）進行系統性文獻回顧與證據評讀；（3）擬訂評估指引草案，（4）使用兩回合德菲法共識決策程序達成共識；（5）將評估指引進行臨床試作，參加者條件為接受紫杉醇、鉑金或併長春花鹼的首次化學治療婦癌病人，研究設計採方便取樣（convenience sampling），收案地點在南部某醫學中心婦產科病房與門診，本研究收集執行30位臨床試作病人，收案病人包括正接受第一次、第三次、第六次化學治療後兩週，以及化學治療結束後，依據指引評估，包括：麻木、麻刺或燒灼感、輕觸覺、針刺覺、振動覺、肌力與肌腱反射、自主神經異常症狀，與工具性日常生活活動量表（IADL）評估。以神經科醫師評估化學治療引發周邊神經病變的結果，作為基準參考的黃金標準；研究者與一位資深護理師分別評估臨床試作病人，以振動感評估作為測試評分者間的一致性；（6）依據臨床試作修訂評估指引；（7）由專家以AGREE II進行指引外部評估，（8）完成指引擬訂，並宣傳與執行。

結果：系統性文獻回顧符合條件文獻17篇，經證據評估與形成建議，擬定指引草案。經由兩次德菲法共識決策程序，擬定指引草案。臨床試作「婦癌化學治療引發周邊神經病變評估指引」：（1）感覺神經方面，使用11點數字評分法，8成有麻木感；使用5.07U（10-gram）Semmes-Weinstein單纖維尼龍絲，7成四肢輕觸感異常；使用牙籤，5成四肢針刺感異常；使用128-Hz Rydel-Seiffer標準音叉，0.7成四肢振動感異常（振幅＜5），3成雙腳振動感異常（振幅＜5）但雙手振動感為正常（振幅≧5）；使用國家癌病組織通用毒性評估表，8成屬於第1級感覺神經病變；（2）運動神經方面，5成四肢肌力為4分；7成踝反射為+，而肱橈肌肌腱、肱二頭肌肌腱、肱三頭肌肌腱，以及膝反射皆為++；使用國家癌病組織通用毒性評估表，6成屬於第1級運動神經病變；（3）自主神經方面，7成病人出現便秘或性慾降低之性功能障礙，6成有全身無力；（4）使用工具性日常生活活動量表（IADL），5-6成病人所有的家事都需要別人協助、需要別人把飯菜煮好、所有衣物都要由別人代洗。以神經科醫師評估化學治療引發周邊神經病變的結果，作為基準參考的黃金標準，以評估麻木感程度之相關係數（R2）最大為0.367，以雙踝的肌腱反射相關係數（R2）最小為0.065；研究者與護理師在振動感評估測試的一致性（Kappa）為0.62，外部評估的整體綜合評價建議採用本指引，但需作部份的修改。

結論：執行「婦癌化學治療引發周邊神經病變評估指引」能早期偵測婦癌化學治療的周邊神經病變與自主神經異常症狀，藉由本指引能協助臨床醫護人員，及早發現化學治療引發周邊神經病變的症狀，給予病人相關照護，提升臨床照護品質。

Standard chemotherapy drugs, including paclitaxel and platinum-based drugs, lead to chemotherapy-induced peripheral neuropathy (CIPN), affecting patients’ sensory or motor peripheral nerves, physical activities, quality of life, and functional status. We aimed to develop evidence-based clinical guidelines to evaluate the severity of and changes in CIPN. The guidelines were developed through the following steps: forming clinical questions with PICO; conducting systematic literature reviews and evidence appraisal; drafting CIPN assessment clinical guidelines; conducting the Delphi process for developing CIPN guidelines; evaluating clinical practice of the guidelines; external evaluation of CIPN clinical guidelines; and publicizing clinical guidelines into execution. Seventeen studies met the inclusion criteria. CIPN clinical guidelines were drafted based on the studies. After a two-step Delphi process, a consensus of the clinical guidelines was archived. The guidelines for CIPN assessment included numbness, tingling or burning sensation, light touch, pin sensibility, vibration sensibility, tendon reflex, muscle strength, automatic functions, and instrumental activities of daily living. The gold standard for the assessments of numbness in the extremities assessed (R2=0.367) and ankle reflex assessed (R2=0.065) by neurologist. The interrater reliability of CIPN assessments by two nurses showed a kappa value of 0.62. The guidelines were externally reviewed by experts who recommended applying the guidelines for gynecologic cancer cases, albeit with certain modifications. Practical clinical guidelines for CIPN assessment are feasible, accessible, and integrated tools that may help in the early detection of CIPN symptoms by oncology nurses.

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