探討頭頸癌病人配偶照顧者的靈性經驗

本研究以頭頸部癌症為範圍，認為癌症病人的配偶照顧者於長時間的照顧歷程會實際經驗到身心負荷，乃至直視死亡恐懼或遭遇失落，成為具有創傷可能性的生活事件。在其調適與因應上，靈性具有關鍵影響，係社會工作者在認識與協助癌症病人配偶照顧者時，需要理解與關懷的重要面向。於研究目的，旨在了解癌症病人配偶照顧者在靈性上的覺察、調適經驗，思維社會工作者如何以靈性為主題提供協助。具體的研究操作，採取質性研究取向，透過敘說研究方法，研究者和6位研究參與者（皆為生理女性、年齡介於35至65歲之間）形成互為主體性的合作對話，產生研究參與者的將述故事（the telling），讓靈性經驗再現，作為可供分析的文本資料。在文本分析方法上，研究者以整體-部分-整體（whole-parts-whole）的詮釋循環，確認文本中的共同主題作為研究所得看見，認為癌症病人配偶照顧者在構成個人靈性經驗上，包含5個主題，分別是：「對自我身分的覺察」；「形成生活信念」；「與他者的關係與愛」，「賦予生命意義與目的」；以及「與超自然的和諧經驗」。其中於生活信念部分有6個關於「我」的訊息：我一定要讓先生活下來；我要比先生更堅強地面對癌症；我要努力給孩子好的成長環境；我可以活出自己想要的生活；我會竭盡全力照顧先生；我能夠平淡看待死亡焦慮。依據研究所得看見，研究者認為癌症病人配偶照顧者於面對困局的瞬時，個人具有朝向自我保存，內在和諧的動力，自靈性經驗構成的任一主題，尋找能作為與悲傷共處，用以支撐個人狀態的力量。作為貼近癌症病人配偶照顧者生活世界的社會工作者，於日常服務實踐，即可能對其靈性產生影響性。惟建議社會工作者若能有意識地就靈性主題形成對話與敘說引導，協助癌症病人配偶照顧者建立復原、成長的獨特故事，則可以是其應對生活挑戰時，可以倚靠的靈性經驗。而為幫助社會工作者具備如是意識與能力，社會工作教育可納入靈性關懷與生命倫理哲思的課程設計。本次研究存在著研究參與者在生理性別上的單一性，以及已處於穩定生活適應狀態等條件。故未來研究可朝向不同屬性背景的研究參與者，用以豐富靈性相關知識累積，裨益社會工作在癌症病人家庭與長期照顧實務有更好的實踐。

關鍵字

靈性經驗；癌症病人配偶照顧者；社會工作實務；敘說研究

並列摘要

This study focuses on head and neck cancer, asserting that spouses of cancer patients experience significant physical and mental burdens over long-term caregiving. They may confront fears of death or face losses, making caregiving a potentially traumatic life event. Spirituality plays a crucial role in their adjustment and coping, an essential aspect that social workers need to understand and address when assisting spouses of cancer patients. The purpose of this study is to understand the spiritual awareness and adjustment experiences of spouses of cancer patients and explore how social workers can provide support with a focus on spirituality. This study employs a qualitative research approach, using narrative research methods. The researcher engaged in collaborative dialogues with six female participants, aged between 35 and 65, to generate narratives (the telling) that recreate their spiritual experiences, serving as text data for analysis. Using a whole-part-whole hermeneutic cycle, the researcher identified common themes in the texts, concluding that the spiritual experiences of spouses of cancer patients consist of five themes: "awareness of self-identity"; "forming life beliefs"; "relationships and love with others"; "giving meaning and purpose to life"; and "harmonious experiences with the supernatural." Within the theme of life beliefs, there are six messages regarding "I": I must ensure my husband survives; I must face cancer stronger than my husband; I must strive to provide a good growing environment for my children; I can live the life I want; I will do my utmost to take care of my husband; I can calmly face death anxiety. Based on these findings, the researcher believes that in moments of facing difficulties, spouses of cancer patients exhibit a drive towards self-preservation and inner harmony, seeking strength from any theme within their spiritual experiences to cope with grief and support their personal state. Social workers, who are close to the daily lives of spouses of cancer patients, can influence their spirituality through their service practices. It is recommended that social workers consciously engage in dialogue and narrative guidance on spirituality, helping spouses of cancer patients build unique stories of resilience and growth, which can serve as spiritual experiences to rely on when facing life challenges. To equip social workers with such awareness and ability, social work education could incorporate curriculum designs on spiritual care and the ethical philosophy of life. This study has limitations, such as the gender homogeneity of participants and their stable life adaptation conditions. Future research could involve participants with different attributes and backgrounds to enrich the accumulation of knowledge related to spirituality, benefiting the practice of social work in cancer patient families and long-term care.