乳癌末期病人及其青少年家屬之安寧團隊整合照護經驗

Hospice care experience of a breast cancer patient and her adolescent family

10.6537/TJHPC.202211_26(3).06

陳宜慶(Yi-Ching Chen)；謝淯唐(Yu-Tang Hsieh)；何仲薇(Chung-Wei He)；陳品雯(Pin-Wen Chen)；黃曉菁(Hsiao-Ching Huang)；周希諴(Hsi-Hsien Chou)

安寧照護 ； 喪親青少年 ； 哀傷輔導 ； palliative care ； adolescent bereavement ； bereavement care

安寧療護雜誌

26卷3期（2022 / 11 / 01）

277 - 289

繁體中文

喪親的歷程對於未成年子女的心理及社會衝擊常常受到忽略，尤其在青少年階段的哀傷有其特殊性，更需醫療團隊的積極介入。本文敘述一位乳癌末期病人之臨終照護過程。因病情變化迅速，先經由藥物調整及身體舒適照護促進病人的舒適感，也協助病人的青少年子女面對喪親的重大壓力事件。因案子女對病況了解有限，安寧照護團隊利用雙重歷程模式分析案子女的心理狀態，給予易於理解的說明，並教導案子女如何互相溝通和處理自身的情感。在時間有限的情境下，整合各專業領域提供全人照護，協助案子女理解並參與個案的醫病溝通。本團隊依照全家照顧的理念，陪伴案子女度過喪親之痛。同時也盤點現有的資源、規劃未來的藍圖，確保案子女的各項權利，達成善終、善別與善生的重要目標。

This article describes the caring experience of a patient with terminally ill breast cancer and her adolescent family. Due to rapid deteriorating of the disease, the adolescent family had little time to adapt this stressful life event. The palliative care team first increased the patient's comfort by medication adjustment and comfort care. We also made effort to inform the adolescent family that the patient was facing a very critical condition via an easy-understanding way. By applying dual process theory, we analyzed the adolescent family's psychological condition and empowered the family about self-care and communication between them. We also gave support in various aspect to ensure that the family had enough resources they needed in the future. Support of bereavement process of adolescent is important not only in emotional aspect, but also has impact on their development and future well-being. By applying holistic and whole family care concept, hospice care team support the adolescent family to better adapt the process of bereavement.

1. 方圓媛,洪佳黛,詹瑞君,李芸湘(2017)。談癌症病人家屬照顧者心理衝擊。榮總護理，34(3)，220-226。
   連結：
2. 吳欣烜,鄭逸如,張琦郁,楊于婷,吳治勳,林耀盛,陳勇仁(2020)。「一切都已經安排好了，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：
3. 汪慧玲,陳怡安,張馨元(2018)。以安寧療護理念協助一位膽管癌末期病人善終之護理經驗。安寧療護雜誌，23(1)，85-98。
   連結：
4. 林佩儀,黃傳永(2020)。以雙歷程模式對喪親青少年悲傷歷程之探究。諮商與輔導，413，30-37+42。
   連結：
5. 林書如,陳慶福(2014)。一位兒童期喪親青少年哀傷經驗之敍說研究。家庭教育與諮商學刊，17，61-89。
   連結：
6. 黃鳳英(2017)。喪親悲慟的見證：社會成員類別分析法的運用。安寧療護雜誌，22(2)，138-163。
   連結：
7. Convention on the Rights of the Child, G.A.Res.44/25, Art.12,U.N.Doc.A/44/49(Nov.20,1989), available at https://www.ohchr.org/en/professionalinterest/pages/crc.aspx
8. Balk, D.(2011).Adolescent development and bereavement: An introduction.The prevention researcher,18(3),3-10.
9. Christ, GH,Siegel, K,Christ, AE(2002).Adolescent Grief: "It Never Really Hit Me...Until It Actually Happened".JAMA,288(10),1269-1278.
10. Coughlin, Kevin(2018).Medical decision-making in paediatrics: Infancy to adolescence.Paediatrics & Child Health,23,138-146.
11. Diekema, D. S.(2020).Adolescent Brain Development and Medical Decision-making.Pediatrics,146(Suppl 1),S18-S24.
12. Ellis, Sarah,Wakefield, Claire,Antill, G.,Burns, Mary,Patterson, Pandora(2016).Supporting children facing a parent’s cancer diagnosis: A systematic review of children’s psychosocial needs and existing interventions.European journal of cancer care,26(1)
13. Oja, C.,Edbom, T.,Nager, A.,Månsson, J.,Ekblad, S.(2020).Informing children of their parent’s illness: A systematic review of intervention programs with child outcomes in all health care settings globally from inception to 2019.PloS one,15(5),e0233696.
14. Stroebe, M.,Schut, H.(1999).The dual process model of coping with bereavement: Rationale and description.Death Studies,23(3),197-224.
15. 史晶瑩(2007)。喪親青少年的喪慟特殊性與悲傷輔導。諮商與輔導，262，21-24。
16. 吳麗貞,蘇英華(2013)。罹癌母親的憂鬱程度、家庭功能與青少年子女行為之相關。護理暨健康照護研究，9(2)，139-147。
17. 李閏華(1998)。臨終關懷中之兒童與青少年喪親者之輔導概念。應用倫理通訊，8，35-42。
18. 張淑容(2015)。國立屏東大學教育心理與輔導學系研究所。
19. 錡姵如,唐婉如,徐亞瑛,高振益(2006)。主要照顧者面對親人死亡之焦慮。安寧療護雜誌，11(4)，383-391。