癌症病人之配偶所面對的心理社會衝擊

Psychosocial Impacts on Spousal Caregivers of Cancer Patients

廖幼婕(Yu-Chien Liao)

《腫瘤護理雜誌》 14卷增訂刊 (2014/12) Pp. 1-12

https://doi.org/10.3966/168395442014121403001

摘要

當面對威脅生命的癌症，配偶是病人最重要的支持者，扮演病人的保護性緩衝之角色。在整個疾病過程中，提供其伴侶身體照護、症狀處理、情緒支持及實質日常活動支持，因此他們承受巨大的壓力及身心負荷，進而造成嚴重的心理痛苦和社會衝擊。然而，癌症病人的配偶之心理社會需求及痛苦，往往是被醫護人員忽視的。高達20%-46%的癌症病人配偶達到臨床憂鬱或焦慮的診斷標準，心理痛苦的程度相當於或甚至高於其罹病的伴侶。配偶在照顧的過程中持續的處於擔憂、害怕失去所愛的人、充滿無望感、無助、失望、對未知的恐懼及不確定感中。在社會層面，配偶面臨角色改變、照顧角色緊張、失去原本的社會網絡，且缺乏充分的社會支持以幫助他們照顧伴侶。配偶的心理社會痛苦，對夫妻雙方的疾病調適及病人結果都會有負向的影響。影響配偶心理痛苦程度的因素包括因應策略、社會支持、夫妻雙方互動及關係、照顧負荷及病人的心理社會痛苦。醫療體系是病人及家庭的正式社會支持資源，護理人員應主動評估配偶的心理痛苦程度、所受的社會衝擊，以及所運用的因應策略，並協助維持社會網絡及運用有效的因應策略。為促進照護品質及病人與配偶的疾病調適，建議醫療體系應增加進階腫瘤護理師的人力，辦理繼續教育以提升臨床人員的諮商能力及家庭護理能力。未來研究應發展及測試以夫妻雙方為主體的介入措施，提供疾病及症狀處置資訊、有效因應策略訓練、夫妻溝通技巧、情緒調節等主題，以協助夫妻雙方降低心理社會痛苦。

關鍵字

癌症病人 ； 配偶 ； 心理痛苦 ； 社會支持 ； 因應策略

並列摘要

When faced with a life-threatening cancer, spouses of the patients are often the primary supporters and protective buffers of patients. Spousal caregivers provide physical care, symptom management, emotional support, and maintenance of instrumental activities of daily living for their partners during the whole illness trajectory. The caregiving tasks are stressful and burdensome and can further result in severe psychological distress as well as social impacts on the caregivers. However, psychosocial distress of spouses of cancer patients is overlooked by healthcare professionals. Empirical evidence has shown that 20%-46% of spouses of cancer patients reported a clinically significant level of depression or anxiety. The morbidity of psychological distress of spouses may be as high as or even higher than their ill partners. During the caregiving process, they continue to experience worries about cancer, fears of loss of the loved ones, hopelessness, disappointment, uncertainty, and fears of unknown future. In the social aspect, the spouses encounter role changes, caregiving role strains, social network constraint, and lack of social support. The psychosocial distress can lead to negative consequences of the couples' adjustment and patients' treatment outcomes. The factors related to the levels of psychosocial distress of spousal caregivers include coping strategies, social support, dyadic interaction and relationship, caregivers' burdens, and patients' psychosocial distress. Health care system is a source of formal social support for patients and their family. Clinical oncology nurses should actively assess the psychological distress and coping strategies of the spouses of cancer patients and assist them in maintaining their social network and applying active coping strategies. To enhance the quality of care and the adjustment ability of cancer patients and their spouses, it is suggested to increase the manpower of advanced oncology nurses. More continuing education programs are necessary to improve the clinicians' capabilities in counseling and family care. Future research focused on developing and testing the effectiveness of couple-based interventions encompassing disease and symptom management, active coping strategy, dyadic communication skill, and emotional regulation is recommended.

並列關鍵字

cancer patients ； spouse caregivers ； psychological distress ； social support ； coping strategy