照護一位罹患胸壁軟骨肉瘤末期病人之經驗

An Experience of Caring a Patient with Terminal Stage of Chondrosarcoma of Chest Wall

10.6880/TJON.202306_23(1).10

吳亭誼(Ting-Yi Wu)；李月麗(Yueh-Lih Li)；沈桂鳳(Kuei-Feng Shen)；江彥萩(Yen-chiu Chiang)；潘慧娟(Hui-Chuan Pan)

胸壁軟骨肉瘤 ； 末期病人 ； 照護經驗 ； Chest Wall ； Chondrosarcoma ； Terminal Stage

腫瘤護理雜誌

23卷1期（2023 / 06 / 01）

115 - 126

繁體中文;英文

本篇個案報告描述一位44歲中年男性罹患軟骨肉瘤末期的病人，照護期間為2019年8月15日至8月24日，筆者藉由會談、觀察、查閱病歷及運用生理、心理、社會及靈性層面進行評估，確立個案有低效性呼吸型態、疼痛、哀傷等健康問題。病人除需調適癌末造成的生理不適外，還須面臨人生即將到生命盡頭與家人生死分離的不捨和擔心，對幼子在成長過程中，自己沒能陪伴在旁感到遺憾，故與家屬討論後協助運用過往相片製成影片檔留給兒子陪伴成長，讓幼子想念父親時，可藉由影片看見父親的身影，並將這份父愛傳遞下去陪伴其成長，以了卻心願，亦讓幼子每天來醫院做短暫的陪伴，讓個案與年幼孩子享受最後天倫之樂，讓他了無牽掛渡過人生最後時光，亦建議與個案兒子溝通時可運用繪本引導其理解的話語與之說明，讓其瞭解父親即將離世，以達到圓滿善終之目的。

This case report describes the nursing care for a 44-year-old male, who was diagnosed with terminal stage of chondrosarcoma, during the period from August 15 to August 24, 2019. The author, through interviews, observations, medical records, and a four dimensions assessment in the aspect of physical, psychological, social, and spiritual, identified the following health problems, which included ineffective breathing pattern, pain, grief and so on. In addition, the patient, while coping with the physical discomfort caused by the cancer, also had to face the end of life and the fear of separation from his family. One of his biggest regrets was that he was unable to spend time with his youngest child or watch him grow up. Therefore, we discussed with his family how to assist in this situation to make his wish come true. We used his old photos to make a video file, which will be used to help his son get to know him as he grows up. Furthermore, he hoped his child could feel his fatherly love coming through the video. In the meantime, his youngest son was brought to the hospital to stay with him. All this allowed him to enjoy the family time in his final days without regrets. It was also suggested that the patient made use of the picture books to express his feelings and help the young child understand that his father was leaving the world, all of which could deliver the goal of a happy ending.

1. 王妍樺,童婉惠,潘慧娟(2019)。協助一位肺癌末期病人善終之護理經驗。腫瘤護理雜誌，19(1)，91-102。
   連結：
2. 李碧玉,柯任桂,顧雅利(2016)。探索老年婦女人生回顧和懷舊活動的個案研究。安寧療護雜誌，21(3)，273-288。
   連結：
3. 許姿均,吳慧絹(2019)。照護一位肺癌末期併骨轉移個案之護理經驗。腫瘤護理雜誌，19，111-122。
   連結：
4. 陳月蓉,王雅芳,郭淑華,楊婉萍(2015)。心慟不捨中放手祝福：一位末期肺癌病人之家屬預期性哀傷撫慰。安寧療護雜誌，20(1)，79-87。
   連結：
5. Caliz, M. J. C.,Rosario, M. G. D.,González-Cancel, I.,González, R. F.,Pagán, J.,Latorre, C. C.,Puebla, J. M. G.,Rodríguez, A. D.(2019).Resection and primary reconstruction of a mas-sive chest wall chondrosarcoma.Oxford Med-ical Case Reports,2019(2),71-75.
6. Lee, C. T.,Tsai, C. C.,Chang, H. T.,Hsu, Y. L.(2016).Primary pulmonary mesenchymal chondrosarcoma: A case report with clinical course and response to radiation.Thoracic Medicine,31(2),108-114.
7. Nguyen, M. T.,Jiang, Y. Q.,Li, X. L.,Dong, J.(2019).Risk factors for incidence and progno-sis in chondrosarcoma patients with pulmonary metastasis at initial diagnosis.Medical Science Monitor,25,10136-10153.
8. World Health Organization (WHO) (1996). Cancer pain relief: With a guide to opioid availability. Retrieved from http://apps.who.int/iris/bit-stream/10665/37896/1/9241544821。
9. Xie, L.,Huang, W.,Wang, H.,Zheng, C.,Jiang, J.(2020).Risk factors for lung metastasis at presentation with malignant primary osseous neoplasms: A population-based study.Journal of Orthopaedic Surgery and Research,15(1),32.
10. 林坤德,謝雅琪,楊鈺雯(2016)。鴉片類藥物在癌症患者的應用。家庭醫學與基層醫療，31(9)，284-289。
11. 林素妃,林秋蘭,蔡佳容(2018)。安寧療護喪親家屬之哀傷輔導服務。北市醫學雜誌，15(3)，1-9。
12. 林逸妍(2017)。台北市，國立臺北教育大學教育學系。
13. 洪立明(2018)。芳香療法在宗教與心靈層面的應用。法印學報，9，193-220。
14. 陳莛翊,林文保(2014)。幼兒園的死亡教育。台灣教育評論月刊，3(10)，69-72。
15. 黃思緯,陳惠珊,施怡如,江淑娟,吳美娟(2019)。一位初次罹患肺癌併惡性肋膜積水面臨死亡恐懼之案例報告。秀傳醫學雜誌，18(1)，32-42。
16. 衛生福利部（2019，6月21日）．107年死因統計年報．取自https://www.mohw.gov.tw/cp-16-48057-1.html。
17. 鄭念慈,楊佩瑄(2018)。一位肺癌骨轉移復發病人之照護經驗。澄清醫護管理雜誌，14(3)，59-68。