[[alternative]]The Experience of Robotic-assisted Laparoscopic Radical Prostatectomy in Middle-age and Elderly

[[abstract]]本研究目的在探討中老年攝護腺癌患者接受機械手臂輔助攝護腺切除術的經驗與感受，採胡塞爾的描述性現象學。以立意取樣方式自2018年1月至9月於台灣北部某醫學中心進行收案。以半結構式訪談指引，紀錄十八位初診斷罹患攝護腺癌，接受機械手臂輔助攝護腺切除術後三至十二個月，年齡介於53-83歲長者的訪談，以Colaizzi（1978）的分析法做資料分析處理。結果顯示中老年攝護腺癌患者接受機械手臂輔助攝護腺切除術的經驗可歸納出五個主題:反覆比較後之治療選擇、漏尿的困擾、性愛關係的變化、停滯與起伏、重整生活與心境。說明中老年攝護腺癌患者，面對診斷接收到多種治療方式，反覆比較後選擇達文西手術。受訪者在沒有心理準備下得知罹患攝護腺癌之後，雖然經歷內心衝擊與不安，最後還是選擇面對治療，雖然術前都得知治療的副作用，但對生活及心理的影響則是要經歷過才明白。接受治療後尿管帶回家、尿管拔除後解尿不順，及陰莖完全無法勃起等身體功能的改變，使得未預期失去身體控制的他們陷入不知所措的狀態，開始擔心這些改變會不會持續到未來的生活，擔心與配偶間的親密關係會不會有所變化。當身體逐漸恢復後，患者開始擔心癌症復發，變得非常在意PSA指數的變化。在這一個治療過程中，患者經歷種種改變，在心境與生活上做了重整，放下忙碌的生活步調及改變生活的模式，更多關注於身體健康，擺脫罹癌的陰霾、迎向癌後的新生活。本研究結果有助於臨床護理人員了解中老年攝護腺癌患者接受機械手臂輔助攝護腺切除術的經驗，提供適切護理與發展攝護腺癌機械手臂輔助攝護腺切除術照護指引之參考。[[abstract]]This study aimed to explore the lived experiences of receiving Robotic-Assisted Laparoscopic Prostatectomy (RALP) among middle-aged and elderly patients with prostate cancer. This study conducted purposive sampling and semi-structured interviewing in a teahing hospital in northern Taiwan from January to September in 2018. Eighteen patients diagnosed with prostate cancer, aged between 53 and 83 years old, 3 to 12 months after receiving Robotic-Assisted Laparoscopic Prostatectomy (RALP) have completed the interview. Colaizzi analysis method was conducted for data analysis. The results showed that the experiences of receiving Robotic-Assisted Laparoscopic Prostatectomy (RALP) among middle-aged and elderly patients with prostate cancer could be summarized into five themes: treatment options upon repeated comparisons, leakage of urine, changes to sexual relationships, stagnation and undulation, and life and mood restructuring. Middle-aged and elderly patients with prostate cancer tended to choose the Da Vinci surgery upon repeated comparison when they faced the diagnosis and multiple treatment options. They were suffering from prostate cancer without any psychological preparation. They finally chose to face treatment after experiencing the inner shock and anxiety. Although they knew that they might experience the side effects of the treatment before the surgery, they describe that the life and psychological impacts can only be understood after the treatment. For participants, the urinary catheter was taken home after the treatment, the urinary tract was not smooth after the urinary catheter been removed, and the penis could not be fully rigid. Those changes of body functions caused them felt lose control over their bodies and they were in a state of being overwhelmed. They began to worry about whether these changes might continue into the future, and whether the intimate relationship with their spouses might change. When the body gradually recovered, the patients began to worry about cancer recurrence and became very concerned about the change of the PSA index. In the treatment process, the patients have undergoes various changes, reorganized the state of mind and life, slowed down the busy pace of life and changed the mode of life. They tended to pay more attention to their physical health and tried to get rid of the shadow of cancer, and usher in a new life after cancer treatment. The results of this study can help clinical nurses understand the experiences of receiving Robotic-Assisted Laparoscopic Prostatectomy (RALP) among middle-aged and elderly patients with prostate cancer. Thus can help them develop the guideline and provide appropriate care for patients with Robotic-Assisted Laparoscopic Prostatectomy (RALP)