透過敘事會談方式協助悲傷中的癌末病人家屬

Narrative interviews with a terminally ill cancer family experiencing anticipatory grief

10.6537/TJHPC.202203_26(2).05

洪翠蓮(Tsui-Lian Hung)；謝依靜(I-Ching Hsieh)；張麗珍(Li-Chen Chang)

預期性悲傷 ； 敘事會談 ； 安寧療護 ； anticipatory grief ； narrative interview ； palliative care

安寧療護雜誌

26卷2期（2022 / 03 / 01）

165 - 177

繁體中文

本文介紹血腫科團隊輔導一位癌末病人的配偶面對預期性悲傷的經驗。當醫療對病人的疾病治療出現極限時，醫療團隊向案妻及家屬們第一次提出安寧療護的建議，但案妻和其他家屬對於病人的治療效果仍抱著期待，未採納安寧療護的建議，也為病人作氣切的決策。在病人氣切之後，意志顯得消沉，與人的互動行為減少。案妻眼見病人的身體漸衰弱和社會功能漸喪失，出現預期性悲傷的反應。本團隊觀察到案妻的心理與社會需求，主動關懷與進行會談。藉由敘事方式探索案妻經歷預期性悲傷的感覺與想法，引導案妻在敘說過程，接納病人癌末的事實，體驗心中的分離焦慮，重整與病人的關係意義，轉化態度接納未來喪偶之後的單親生活。

This article describes the experience of the hematology and oncology team in counseling the spouse of a patient with advanced cancer with anticipatory grief. When the patient's condition worsened, the medical team suggested hospice care to his wife and other family members for the first time. However, the wife along with other family members did not follow the recommendation for hospice care. In addition, the patient's wife and other family members made the decision for the patient to undergo a tracheostomy. After the tracheostomy operation, the patient became distressed and reduced interactions with others. Witnessing the patient's gradual physical deterioration and loss of social functioning, the wife started to show anticipatory grief reactions. The team observed her psychological and social needs and took the initiative to provide care and counseling. Through the narrative interviews, the team helped the wife explore the feelings and thoughts she had while experiencing anticipatory grief and guided her to accept that the patient was dying, feel the separation anxiety, reorganize the meaning of her relationship with the patient, and move on to her future life as a single parent following the loss of her spouse.

1. 吳欣烜,鄭逸如,張琦郁(2020)。「一切都已經安排好，不用擔心。」解析與了解照顧者的理智化因應。安寧療護雜誌，24(1)，47-58。
   連結：
2. 洪韡倢,邱秀渝,洪芳明(2016)。外科重症病患生命末期 CPR 意願與家屬醫療決策之探討。安寧療護雜誌，21(3)，258-272。
   連結：
3. 萬宣慶,周盈邑,張冠民,董鈺琪(2020)。癌症與非癌生命末期病人使用安寧療護對照護利用及費用的影響。台灣公共衛生雜誌，39(2)，187-201。
   連結：
4. 葉忻瑜,黃獻樑,蔡兆勳(2016)。安寧團隊提供末期病人及家屬照護與悲傷輔導經驗。安寧療護雜誌，21(2)，218-227。
   連結：
5. 董芸庭,高綺吟,孫婉娜(2020)。運用善終概念協助肝癌末期病人家屬決策歷程之護理經驗。志為護理，19(1)，115-125。
   連結：
6. Coelho, A,Brito, M,Teixeira, P,Frade, P,Barros, L,Barbosa, A(2020).Family caregivers’ anticipatory grief: a conceptual framework for understanding its multiple challenges.Qualitative health research,30(5),693-703.
7. Coelho, A,de Brito, M,Barbosa, A.(2018).Caregiver anticipatory grief: phenomenology, assessment and clinical interventions.Current opinion in supportive and palliative care,12(1),52-57.
8. Coombs, MA(2010).The mourning before: can anticipatory grief theory inform family care in adult intensive care?.International journal of palliative nursing,16(12),580-584.
9. DuBenske, LL,Gustafson, DH,Namkoong, K(2014).CHESS improves cancer caregivers’ burden and mood: Results of an eHealth RCT.Health psychology,33(10),1261-1272.
10. Hashemi, M,Irajpour, A,Taleghani, F(2018).Caregivers needing care: the unmet needs of the family caregivers of end-of-life cancer patients.Supportive care in cancer,26(3),759-766.
11. Nielsen, MK,Neergaard, MA,Jensen, AB,Bro, F,Guldin, MB(2016).Do we need to change our understanding of anticipatory grief in caregivers? A systematic review of caregiver studies during end-of-life caregiving and bereavement.Clinical psychology review,44,75-93.
12. Odagiri, T,Morita, T,Aoyama, M(2018).Families’ sense of abandonment when patients are referred to hospice.The oncologist,23(9),1109-1115.
13. Orr, RD.(2010).Medical ethics and the faith factor: the endangered right of conscience.An international journal of bioethics,26(1),49-54.
14. Toyama, H.,Honda, A.(2016).Using narrative approach for anticipatory grief among family caregivers at home.Global qualitative nursing research,3,1-15.
15. Valentine, C.(2019).Valentine CMeaning-making in bereavement and grief.Bereavement care,38(1),42-45.
16. Vig, E. K.,Starks, H.,Taylor, J. S.,Hopley, E. K.(2007).Fryer-Edwards, K.Surviving surrogate decision-making: what helps and hampers the experience of making medical decisions for others.Journal of general internal medicine,22(9),1274-1279.
17. 李佩怡,李曉芬,林家民,徐玟玲,許馨勻,黃傳永,羅靜伃,蘇彙(2016)。李佩怡、李曉芬、林家民、徐玟玲、許馨勻、黃傳永、羅靜伃、蘇彙。悲傷療癒卡。2016：國立台北護理健康大學、社團法人台灣失落關懷與諮商協會。
18. 胡瑞芝(2013)。悲傷轉化的力量：論敘事治療與意義治療。台灣神學論刊，36，150-167。
19. 陳采熏(2012)。新竹，國立交通大學教育研究所。
20. 程國斌(2017)。當代中國家庭醫療決策的倫理策略──一個有關家庭醫療決策的案例研究。中外醫學哲學，15(2)，21-41。
21. 劉乃誌,李英芬,劉景萍,賴允亮(2005)。安寧療護與預期性悲傷。安寧療護雜誌，10(3)，286-296。
22. 蔡甫昌,郭蕙心(2017)。病人自主權利法之倫理觀點與實務挑戰。台灣醫學，21(1)，62-72。