末期病人失志對靈性安適之影響

The Impact of Demoralization on Spiritual Well-Being in Terminally Ill Patients

10.6224/JN.201902_66(1).07

劉美玲(Mei-Ling LIU)；蕭雅竹(Ya-Chu HSIAO)

末期病人 ； 失志 ； 靈性安適 ； terminal-illness patient ； demoralization ； spiritual well-being

護理雜誌

66卷1期（2019 / 02 / 01）

48 - 59

繁體中文

背景：末期病人常有失志症狀進而影響靈性安適，有關失志與靈性安適相關研究尚屬起步階段，不論是失志與靈性兩者的相關性或是失志照顧模式的建立，都需要更多研究加以驗證與支持。目的：探討末期病人失志狀態、靈性安適現況與其影響因素，以及了解末期病人背景資料、疾病特性、失志對靈性安適的預測性。方法：本研究以橫斷式相關性研究設計，以南部某教學醫院接受安寧療護之末期病人為對象，以結構式問卷收集研究資料。研究工具包括失志量表、靈性安適量表與基本人口學資料。以皮爾森績差相關及階層多元迴歸分析兩者的相關性與失志對靈性安適的預測。結果：共82位研究對象參與本研究，81.7%屬高失志狀態，靈性安適平均得分為31.7分，屬中等程度之靈性安適狀態。失志得分與靈性安適得分呈顯著負相關（r = -.600, p ＜ .01），回歸分析結果發現控制人口學特性、疾病特性等變項，失志得分能有效預測靈性安適得分（解釋力達12.7%，β = -.41，p ＜ .001），顯示失志程度越高，靈性安適程度則越低。結論／實務應用：失志是末期病人常見之問題，且為影響末期病人靈性安適之重要因素之一。因此，臨床上應及早評估與辨識病人失志狀態，建立失志相關的照護模式，以協助末期病人靈性安適。

Background: Terminally ill patients often experience demoralization, which negatively impacts their spiritual wellbeing. However, studies on the relationship between demoralization and levels of spiritual well-being in Taiwan are still at an early stage. Thus, more research is required to verify and support the correlation between demoralization and spirituality and to establish methods to care for and treat demoralization. Purpose: The purposes of this study were to investigate the demoralization and spiritual-well-being status of terminally ill patients and to determine the value of demographic data, disease characteristics, demoralization in predicting spiritual well-being. Methods: A cross-sectional research design was used to evaluate terminally ill patients who were currently receiving hospice care at a teaching hospital in southern Taiwan. Data were collected using a structured questionnaire that included a demographic datasheet and the Chinese demoralization and spiritual well-being scale. Pearson product-moment correlation and hierarchical multiple regression were performed to analyze the relationship between the target variables and spiritual well-being. Results: Of the 82 participants surveyed, 81.7% had high levels of demoralization. The average spiritual well-being score for the participants was 31.7 (moderate). A significant and negative correlation was found between degree of demoralization and level of spiritual well-being (r = -.600, p ＜ .01). Regression analysis showed that, after controlling for demographic characteristics, disease characteristics, and other variables, demoralization scores were shown to predict the spiritual-well-being score, explaining 12.7% of total variance (β = -.41, p ＜ .001). In other words, higher demoralization was associated with lower spiritual well-being. Conclusions: Demoralization is a common problem in people with terminal illnesses and is an important factor affecting spiritual well-being in this patient population. In clinical practice, early assessment and identification of demoralization in patients as well as establishing relevant models of care for demoralization are necessary to help patients attain spiritual well-being at the end of life.

1. 李玉琪, Y. C.,周汎澔, F. H.,王秀紅, H. H.(2015)。失志的概念分析。護理雜誌，62(3)，83-88。
   連結：
2. 陳怡如, Y. J.,余文瑞, W. R.,何清幼, C. Y.(2012)。某社區醫院安寧團隊照護模式初探。台灣家庭醫學雜誌，22(3)，130-140。
   連結：
3. 趙可式, C. S.(2015)。安寧療護是普世價值且為護理的本質。護理雜誌，62(2)，5-12。
   連結：
4. Best, M.,Aldridge, L.,Butow, P.,Olver, I.,Price, M.,Webster, F.(2015).Assessment of spiritual suffering in the cancer context: A systematic literature review.Palliative and Supportive Care,13(5),1335-1361.
5. Bovero, A.,Leombruni, P.,Miniotti, M.,Rocca, G.,Torta, R.(2016).Spirituality, quality of life, psychological adjustment in terminal cancer patients in hospice.European Journal of Cancer Care,25(6),961-969.
6. Bredle, J. M.,Salsman, J. M.,Debb, S. M.,Arnold, B. J.,Cella, D.(2011).Spiritual well-being as a component of health-related quality of life: The functional assessment of chronic illness therapy–Spiritual well-being scale (FACIT-Sp).Religions,2(1),77-94.
7. Castaldelli-Maia, J. M.,Bhugra, D.(2014).Investigating the interlinkages of alcohol use and misuse, spirituality and culture - Insights from a systematic review.International Review of Psychiatry,26(3),352-367.
8. Chaturvedi, S. K.(2007).Spiritual issues at end of life.Indian Journal of Palliative Care,13(2),48-52.
9. Dalby, P.(2006).Is there a process of spiritual change or development associated with ageing? A critical review of research.Aging & Mental Health,10(1),4-12.
10. Edwards, A.,Pang, N.,Shiu, V.,Chan, C.(2010).Review: The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: A meta-study of qualitative research.Palliative Medicine,24(8),753-770.
11. Ellison, C. W.(1983).Spiritual well-being: Conceptualization and measurement.Journal of Psychology and Theology,11(4),330-338.
12. Faul, F.,Erdfelder, E.,Lang, A.-G.,Buchner, A.(2007).G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.Behavior Research Methods,39(2),175-191.
13. Grassi, L.,Nanni, M. G.(2016).Demoralization syndrome: New insights in psychosocial cancer care.Cancer,122(14),2130-2133.
14. Heinrich, R. L.,Schag, C. C.,Ganz, P. A.(1984).Living with cancer: The cancer inventory of problem situations.Journal of Clinical Psychology,40(4),972-980.
15. Julião, M.,Nunes, B.,Barbosa, A.(2016).Prevalence and factors associated with demoralization syndrome in patients with advanced disease: Results from a cross-sectional Portuguese study.Palliative and Supportive Care,14(5),468-473.
16. Kelly, B.,Burnett, P.,Pelusi, D.,Badger, S.,Varghese, F.,Robertson, M.(2002).Terminally ill cancer patients’ wish to hasten death.Palliative Medicine,16(4),339-345.
17. Kissane, D. W.,Clarke, D. M.,Street, A. F.(2001).Demoralization syndrome -- A relevant psychiatric diagnosis for palliative care.Journal of Palliative Care,17(1),12-21.
18. Kissane, D. W.,Wein, S.,Love, A.,Lee, X. Q.,Kee, P. L.,Clarke, D. M.(2004).The demoralization scale: A report of its development and preliminary validation.Journal of Palliative Care,20(4),269-276.
19. Lee, C. Y.,Fang, C. K.,Yang, Y. C.,Liu, C. L.,Leu, Y. S.,Wang, T. E.,Chen, H. W.(2012).Demoralization syndrome among cancer outpatients in Taiwan.Supportive Care in Cancer,20(10),2259-2267.
20. Li, Y. C.,Ho, C. H.,Wang, H. H.(2017).Demoralization in cancer patients and related factors in Taiwan.Cancer Nursing,40(1),E54-E60.
21. Lindberg, D. A.(2005).Integrative review of research related to meditation, spirituality, and the elderly.Geriatric Nursing,26(6),372-377.
22. McClain, C. S.,Rosenfeld, B.,Breitbart, W.(2003).Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients.The Lancet,361(9369),1603-1607.
23. Mehnert, A.,Vehling, S.,Höcker, A.,Lehmann, C.,Koch, U.(2011).Demoralization and depression in patients with advanced cancer: Validation of the German version of the demoralization scale.Journal of Pain and Symptom Management,42(5),768-776.
24. Mok, E.,Wong, F.,Wong, D.(2010).The meaning of spirituality and spiritual care among the Hong Kong Chinese terminally ill.Journal of Advanced Nursing,66(2),360-370.
25. Morita, T.,Tsunoda, J.,Inoue, S.,Chihara, S.(2000).An exploratory factor analysis of existential suffering in Japanese terminally ill cancer patients.Psycho-Oncology,9(2),164-168.
26. Peterman, A. H.,Fitchett, G.,Brady, M. J.,Hernandez, L.,Cella, D.(2002).Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy--Spiritual well-being scale (FACIT-Sp).Annals of Behavioral Medicine,24(1),49-58.
27. Robinson, S.,Kissane, D. W.,Brooker, J.,Burney, S.(2015).A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: A decade of research.Journal of Pain and Symptom Management,49(3),595-610.
28. Rykkje, L. L. R.,Eriksson, K.,Raholm, M. B.(2013).Spirituality and caring in old age and the significance of religion: A hermeneutical study from Norway.Scandinavian Journal of Caring Sciences,27(2),275-284.
29. Tecuta, L.,Tomba, E.,Grandi, S.,Fava, G. A.(2015).Demoralization: A systematic review on its clinical characterization.Psychological Medicine,45(4),673-691.
30. Vehling, S.,Kissane, D. W.,Lo, C.,Glaesmer, H.,Hartung, T. J.,Rodin, G.,Mehnert, A.(2017).The association of demoralization with mental disorders and suicidal ideation in patients with cancer.Cancer,123(17),3394-3401.
31. Vehling, S.,Lehmann, C.,Oechsle, K.,Bokemeyer, C.,Krüll, A.,Koch, U.,Mehnert, A.(2011).Global meaning and meaning-related life attitudes: Exploring their role in predicting depression, anxiety, and demoralization in cancer patients.Supportive Care in Cancer,19(4),513-520.
32. Vehling, S.,Oechsle, K.,Koch, U.,Mehnert, A.(2013).Receiving palliative treatment moderates the effect of age and gender on demoralization in patients with cancer.PLoS ONE,8(3),e59417.
33. World Health Organization. (2002). National cancer control programmes: Policies and managerial guidelines (2nd ed.). Retrieved from http://www.who.int/cancer/media/en/408.pdf
34. Yonker, J. E.,Schnabelrauch, C. A.,DeHaan, L. G.(2012).The relationship between spirituality and religiosity on psychological outcomes in adolescents and emerging adults: A meta-analytic review.Journal of Adolescence,35(2),299-314.
35. Zimmermann, C.,Swami, N.,Krzyzanowska, M.,Hannon, B.,Leighl, N.,Oza, A.,Lo, C.(2014).Early palliative care for patients with advanced cancer: A cluster-randomised controlled trial.The Lancet,383(9930),1721-1730.
36. 內政部戶政司（2016）．人口資料庫．取自https://www.ris.gov.tw/346 [Department of Household Registration, Ministry of the Interior, Taiwan, ROC. (2016). Demographic database. Retrieved from https://www.ris.gov.tw/346]
37. 方俊凱, C. K.(2013)。癌症病人的失志症候群。台灣醫學，17(2)，149-154。
38. 李隆軍, L. C.,胡中傑, C. C.,黃曉峰, S. F.,林鉅勝, C. S.,張瑛瑛, Y. Y.(2011)。癌症末期病人安寧居家的主要照顧議題分析。安寧療護雜誌，16(2)，151-167。
39. 林沄萱, Y. H.,劉淑惠, S. H.,陳清惠, C. H.(2008)。靈性護理之臨床應用。護理雜誌，55(3)，69-74。
40. 洪曉琪, H. C.,陳虹汶, H. W.,張義芳, Y. F.,楊育正, Y. C.,劉建良, C. L.,謝瑞坤, R. K.,方俊凱, C. K.(2010)。癌症病人失志量表中文版之信效度檢測。內科學誌，21(6)，427-435。
41. 鄭如芬, J. F.,林雅卿, Y. C.,黃百后, P. H.,韋至信, C. H.,孫嘉玲, J. L.(2014)。癌症末期病人靈性照護模式。護理雜誌，61(6)，93-97。

1. 潘雪幸,林靖雅(2022)。一位胃癌末期老人生命回顧之安寧療護經驗。長庚護理，33(3)，88-98。
2. 蕭雅竹,蔡坤宏,蔣宜倩,劉曉慧,朱宗藍(2023)。血液透析病人靈性健康狀態與相關因素探討。長庚護理，34(1)，16-29。
3. (2023)。一般居家護理轉銜安寧靈性照護於腎細胞癌個案護理經驗。嘉基護理，23(2)，33-42。
4. (2024)。探討癌症病人失志程度與主要照顧者照顧負荷之相關與影響因子。長庚護理，35(3)，13-28。