安寧團隊提供末期病人及家屬照護與悲傷輔導經驗

Case Report for Experiences of Anticipatory Grief Counseling in Hospice Care

10.6537/TJHPC.2016.21(2).8

葉忻瑜(Shin-Yu Yeh)；黃獻樑(Hsien-Liang Huang)；蔡兆勳(Jaw-Shiun Tsai)

安寧療護 ； 癌末 ； 預期性悲傷 ； hospice care ； terminally cancer patient ； anticipatory grief

安寧療護雜誌

21卷2期（2016 / 07 / 01）

218 - 227

繁體中文

本文主要報告某醫學中心安寧病房團隊（包含醫師、護理師、心理師、社工師、宗教師及志工）照護一位肝癌末期病人與進行家屬預期性悲傷輔導的經驗。病人為55 歲男性，2014 年10 月因腹痛求醫進而檢查出末期肝癌，接受過兩次栓塞治療，病情依舊持續惡化。2015 年底，病人開始承受肝衰竭所引起的身體不適如腹水、腹脹、腳腫；於2015 年12 月入住安寧病房接受安寧照護。入院後，團隊針對個案進行生理、心理、社會及靈性層面的整體性評估；不僅致力於身體症狀的緩解，更經由召開家庭會議及團隊會議，瞭解病人餘生期待及心靈需求，邀請家屬一同完成病人心願完及善終準備。病人太太對於病人疾病惡化，除表現不捨情緒外，同時出現焦慮、害怕、失眠、愧疚自責等情緒反應；病人也同樣流露出不捨的悲傷情緒。團隊除照護病人外，同時針對太太的預期性悲傷進行評估，同時轉介心理師、宗教師協助教導兩人壓力因應技巧。安寧團隊照護強調全人、全家、全隊、全程四全照護；除了病人的身體照顧外，更含括病人及家屬的心理靈性照顧。如何避免失落情緒及悲傷影響病人身體症狀及對於整個家庭的影響，亦是安寧療護的重要工作之一。

In this report, we describe the experiences of caring a patient with terminal hepatocellular carcinoma and in engaging in whole family anticipatory grief counseling. The 55-year-old patient was diagnosed with terminal hepatocellular carcinoma in Oct, 2014. He had discomfort symptoms of hepatic failure, such as ascites, abdominal fullness and lower leg edema. He was admitted to hospice ward in Dec, 2015 due to the deterioration of clinical condition. After admission, the patient's physiological, psychological, and spiritual aspects were comprehensively assessed. We arranged family conferences to explore the expectation for patient's remaining life, to complete his final wishes. Anticipatory grief is the major response for the patient and main caregiver when patient's condition deteriorated toward the death. Our hospice care team members involved in fulfilling patient's last wishes, offering empathy and providing proper companionship. Furthermore, we also gave the families support to cope with their grief. Hospice care focuses on the holisticity which consists of caring for the whole person, whole family, whole team and whole course. To achieve the goal of good death, it's imperative for hospice care team to be devoted in resolving not only patient's physical problems but also psychosocial and spiritual distress of the whole family.

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