臨床宗教師照顧對癌末病人善終指數之提昇

Clinical Buddhist Chaplain's Care Enhanced the Good Death Index of Terminal Cancer Patients

陳慶餘(Ching-Yu Chen) ； 邱泰源(Tai-Yuan Chiu) ； 胡文郁(Wen-Yu Hu) ； 釋宗惇(Tsung-Tueng Bhikkhuni) ； 黃鳳英(Feng-Ying Huang) ； 釋惠敏(Hui-Ming Bhikkhu)

《安寧療護雜誌》 8卷1期 (2003/02) Pp. 13-27

https://doi.org/10.6537/TJHPC.2003.8(1).2

摘要

本研究針對2001年1-8月期間，緩和醫療病房187名入院病人為主要調查對象，以有否宗教師提供的直接照顧區分為照顧組與對照組，分析癌末病人善終的影響因素。調查分析對照組病人住院時與往生時的各項善終指數（包括「瞭解自己死之將近」、「心平氣和接受」、「後事交代安排」、「時間恰當性」、「去世前三天舒適性」等五項）及善終總分，除瞭「後事交代安排」一項外，往生時之善終指數皆較住院時之善終指數來得高，表示緩和醫療團隊照顧對病人的善終有正向的影響，但「後事交代安排」無顯著差异。進一步檢視對照組病人與照顧組病人各項善終指標之相關性，結果發現有宗教師提供直接照顧之照顧組病人的五項善終指數及善終總分均較前者高，顯見臨床宗教師的參與照顧更有助於善終的達成。為了更加瞭解臨床宗教師照顧對病人善終的影響，針對各項因素作進一步分析。在法師提供的服務方面，協助病人及家屬面對死亡及宗教儀式的諮詢，有助於善終指數的提昇；法門應用部分，皈依及念佛法門之施作有助於病人心平氣和的接受死亡；皈依及懺悔法門則有助於去世前三天的舒適性；另外，臨終說法與助念對「心平氣和接受」、「後事交代安排」、「時間恰當性」有顯著影響。當法師提供為病人作靈性評估、擬定照顧計畫及執行三項照顧，病人在「瞭解自己之將至」、「心平氣和接受」、「後事交代安排」、「時間恰當性」及「善終總分」有明顯提昇。此外，當法師協助病人完成「遺願交代」、「佛法修持」及「來生期待」三項死亡準備工作時，其善終指數亦為正向成長。由調查結果得知，臨床佛教宗教師專業照顧的參與确實對癌末病人之善終指數有更大助益，本研究再次肯定臨床佛教宗教師作為緩和醫療團隊專業的靈性照顧人員，是不可或缺的角色。

關鍵字

緩和醫療 ； 靈性照顧 ； 善終 ； 佛教宗教師

並列摘要

The study intended to evaluate the spiritual services provided by clinical Buddhist chaplains. We investigated 187 patients who admitted to palliative care ward at a medical center from Jan. to Aug. 2001. The good death index was assessed after patient death by team members using Linkert 4 points. There were five indicators with a total score of 15 points consisting of awareness, acceptance propriety, timeliness and comfort. It indicated that the palliative care team with chaplain service further improved all good death indicators and total score. Various professional services provided by clinical Buddhist chaplain associated with good death index were examined. The results were shown as follows. In the respect of Buddhist chaplain service provided, helping the patients and relatives to face death and consultation of religion ceremony aided the elevation of acceptance indicator. In the respect of the Buddhist means being applied, taking refuge to Buddha and the recitation of Buddha sname helped patients to calmly accept death. In the respect of taking refuge and confession techniques, it helped the improved comfort three days prior to death. Besides, the explanation of Buddha dharma at the time of dying and the recitation of Buddha s name at the time of dying had significant impact on indicators of acceptance, propriety and timeliness. As Buddhist chaplains did the spiritual evaluation, purpose caring projects and carried out the projects, patients in knowing of forthcoming death, the three indicators (acceptance, propriety and timeliness) and total score of good death showed distinct progress. Furthermore, when Buddhist chaplains helped patients to complete the will, Buddhist practice and expectation for next life, the above three indicators of good death before death preparations also had a substantial growth. In conclusion, participation of clinical Buddhist chaplain's professional care surely is the best advantage of good death for terminal cancer patients.

並列關鍵字

palliative medicine ； spiritual care ； good death ； Buddhist chaplain