從癌症病人及家屬觀點探討病情告知之經驗

The Experience of Truth-Telling from Cancer Patients and Families’ Perspectives

郭淑芬(Shu-Fen Kuo)

指導教授 ： 胡文郁

國立臺灣大學/醫學院/護理學研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.02287

摘要

本研究為問卷調查法，旨在探討癌症病人及家屬被告知癌症病情之實際經驗、理想方式以及其障礙因素。研究對象為住院的癌症病人及家屬，採立意取樣，於北市某醫學中心及腫瘤專科醫院，以結構性問卷面對面訪談方式進行資料收集，共收案53位病人，66位家屬，所得資料以SPSS11.0版之套裝軟體進行統計分析。主要研究結果為：
1 )癌末病情告知比例比癌症診斷告知比例低；2）病人及家屬被告知癌症病情實際經驗主要由主治醫師告知（79.2％、63.6％），其中病人的癌末病情有40.0％是由家屬告知；病情告知的時機，大多數病人及家屬在有醫學檢查報告後，被告知（73.6％、56.1％），而癌末病情在病情惡化時才告知病人的有33.3％，家屬則是26.3％，其他在告知者的語氣態度、以及病情的內容上，癌症診斷與癌末病情的告知有顯著的差異。3）在病人被告知癌末病情實際經驗

關鍵字

經驗 ； 障礙因素 ； 病情告知 ； 癌末

並列摘要

The purpose of this study were to investigate the experience of truth-telling on cancer patients and families, and to explore an ideal way for executing truth-telling and its obstacles. Questionnaire survey was employed in this study. The subjects were 53 cancer inpatients and 66 family members conveniently recruited from a medical center and a cancer comprehensive center in Taipei. The data was collected by a structured questionnaire. The collected data were analyzed using SPSS11.0. The findings were as follows: 1) There is a lower percentage of health providers to tell terminal information than to disclose cancer diagnosis. 2) 79.2％ of patients and 63.6％ of families were informed the cancer information by physicians, and 40.0％ of patients were informed by their family members directly. 73.6％ of patients and 56.1％ of families were informed after examination completed. 33.3％ of patients and 26.3% of families were informed after aggravation of the patient’s condition. There was a significant difference between telling terminal information and cancer diagnosis on the attitude of the truth teller. 3) According to the patient’s experience on being told the truth, the natural development of the disease, the weakness of doing aggressive therapy continuously, and the impact of the disease on life were seldom discussed. After truth- telling, the physicians rarely took care of the patient’s psychological response. The nurses seldom played any role during truth-telling, which is not in accordance to patient’s expectation. 4) The greatest factor influenced family’s willingness to tell the truth is patient’s emotional steadiness（89.1％）. The older the patient, the more unwillingness of his/her family to tell the truth (χ2＝4.69, p＜.05）.
In conclusion, it was a difficult situation in informing terminal information, and the family member’s willingness was the greatest factor. As to truth-telling, physicians and nurses were should help the families to overcome the dilemma of truth-telling, and decrease the discrepancy between the patient’s expectation and real situation. This will help increase patients’ autonomy and thus promote the quality of terminal medicinal caring.

並列關鍵字

experience ； truth-telling ； cancer ； puzzle

參考文獻

最新修正安寧緩和醫療條例全文 (民91)。安寧療護雜誌，7（4），355。

許禮安 (民91)。病情世界初探－由病情告知談起。安寧療護雜誌，7(3)，239-250。

李明濱、廖士程 (民90)。心理腫瘤學概說。國防醫學，5(4)，407-414。

楊克平、尹祚芊 (民88)。癌末病患健康相關生活品質內涵之研究。護理研究，7(2)，129-143。

許惠珍 (民87)。癌症死亡家屬對現行癌末醫療需求及其安寧療護之認知與態度之探討-高雄市。私立高雄醫學院公共衛生所碩士論文，未出版，高雄市。