以病人為中心的溝通模式於一位孕期罹患肺癌個案之護理經驗

Applying Patient-Centered Communication Model to Care for a Lung Cancer Patient during Pregnancy

10.29494/LN.202312_24(4).0008

柯虹如(Hong-Ru Ke)；王雅青(Ya-Ching Wang)；崔宛玉(Wan-Yu Tsui)

孕期罹癌 ； 癌症照顧 ； 以病人為中心 ； cancer during pregnancy ； patient-centered communication ； oncological management

領導護理

24卷4期（2023 / 12 / 01）

99 - 114

繁體中文;英文

本文是描述一位雙胞胎孕婦罹患肺癌第四期，因腫瘤壓迫心臟，孕期30週提早剖腹生產，個案同時面對新生及死亡生命衝擊，筆者為個案之肺癌個案管理師，照護期間為2021年9月27日至11月15日，藉由觀察及深入訪談，進行生、心、靈、家庭及角色功能評估，確立主要健康問題為「心靈困擾」、「潛在危險性依附關係障礙」、「因應能力失常」，依據美國國家癌症研究院以病人為中心的溝通模式六項原則「促進治癒性關係」、「回應情緒」、「交換訊息」、「管理不確定感」、「做出決策」及「促進患者自我管理」提供癌症實證照護，透過個案管理連續性的照顧，並引導個案藉由中國文化對宿命論及母親的天職而找到生命的意義，家人的參與照顧，願意遵從治療，共同訂立出院計劃順利返家，整個家庭正向因應孕期罹癌歷程，與癌共存。經文獻查詢，目前並無針對孕期罹患晚期肺癌的照顧經驗，以此護理經驗，作為臨床照護之參考。

This article describes a pregnant woman with twins suffering from the fourth stage of lung cancer. Because the tumor oppressed her heart, she had an early caesarean section at 30 weeks of pregnancy, and the case is facing the impact of new life and her own death at the same time. The author served as the patient’s oncology case manager from September 27 to November 15 in 2021. Data were collected through observation and in-depth interviews, conduct physical, mental, spiritual, family and role function assessments, and hence identify the main health problems such as "spiritual distress " ," risk of impaired attachment ", and " ineffective coping " . The author based on the six principles of the National Cancer Institute's Patient-Centered Communication Model such as, "Fostering Healing Relationships", " Exchanging Information ", " Responding to Emotions ", " Managing Uncertainty", " Making Decisions" and " Enabling Patient Self-Management Promote healing " for providing evidence-based care to the cancer patient. Through continuous care for case management, the patient was guided to discover the meaning of life through Chinese cultural fatalism and motherhood vocation. The family participated in this care, the patient was willing to comply with the treatment, and jointly establishes a discharge plan to return home smoothly. The whole family is responding positively to the journey of cancer during pregnancy and living with cancer. As research showed no experiences shared in caring for patients with advanced lung cancer during pregnancy so far, this nursing experience can therefore be used as a reference for clinical care.

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