運用FOCUS家庭介入措施於大腸直腸癌末期病人及其配偶之照護經驗

Using the FOCUS Family Intervention in Caring for a Patient-Spouse Dyad With Advanced Colorectal Cancer

郭軒如(Hsuan-Ju Kuo) ； 張馨元(Sin-Yuan Jhang) ； 孫秀卿(Shiow-Ching Shun)

《護理雜誌》 64卷3期 (2017/06) Pp. 98-104

https://doi.org/10.6224/JN.000045

摘要

配偶常是癌症病人的主要照顧者，且其生理健康、情緒狀態、社交功能等受癌症病人的負向影響，造成生活品質降低，其衝擊不亞於癌症病人本身。為同時因應病人及配偶的需要，配對照護（dyadic care）措施因而衍生；然而，目前國內臨床上仍少見配對照護措施的應用。本個案為一大腸直腸癌末期合併惡性腸阻塞病人，除了面臨身心靈的衝擊，主要照顧者也背負著壓力，造成彼此的關係緊張。本文即應用FOCUS家庭介入措施（FOCUS family intervention）為架構，並搭配實證照護指引為輔佐，提供個案及案妻配對照顧，增進其家庭參與、正向態度、有效因應方式、症狀處理、維持希望等能力，同時降低不確定感，使個案及配偶在面對疾病的過程中達到更好的調適，期望能提供臨床護理人員於照顧癌症病人及其配偶之應用參考，以提升護理照護品質。

關鍵字

大腸直腸癌 ； 家庭介入措施 ； 配對照護 ； FOCUS計畫

並列摘要

The care-related burdens of the spouses of advanced cancer patients often impact negatively on their physical health, emotional well-being, social functioning, and quality of life. Thus, dyad interventions have been created to meet the demands of advanced cancer patients and their spouses. However, the application of dyadic care in clinical settings is currently rather limited in Taiwan. The present case study involved a patient with advanced colorectal cancer and malignant bowel obstruction whose disease-related demands had eroded the patient's physical, psychological, and spiritual health. The patient's condition placed overwhelming stress on the spouse, jeopardizing the relationship of the dyad. This article elaborates the implementation of the FOCUS program with the goal of helping the dyad achieve better disease adjustment through family involvement, optimistic attitude, effective coping, better symptom management, and uncertainty reduction. Through this delineated experience, the authors hope to help healthcare providers achieve a higher quality of care while caring for patient-family dyads with colorectal cancer.

並列關鍵字

colorectal cancer ； family intervention ； dyadic care ； FOCUS program

參考文獻

柳秋芳、徐書儀、簡淑慧（2014）．從實證觀點談─緩解癌症病人家屬負荷之介入處置．腫瘤護理雜誌，14（增訂刊），59–70。[Liou, C. F., Hsu, S. Y., & Jane, S. W. (2014). Interventions to reduce strain on caregivers of cancer patients: An evidence-based approach. The Journal of Oncology Nursing, 14(Suppl.), 59–70.] doi:10.3966/168395442014121403005

莊春蜜、張育萍（2004）．運用希望建立技巧於一位癌末無望感患者之照護經驗．護理雜誌，51（1），106–111。[Juang, C. M., & Chang, Y. P. (2004). Helping a terminal cancer patient establish hope. The Journal of Nursing, 51(1), 106–111.] doi:10.6224/JN.51.1.106

黃麗霞、許煌汶（2010）．惡性腸阻塞的緩和醫療．安寧療護雜誌，15（2），219–228。[Huang, L. H., & Hsu, H. W. (2010). Palliative care for malignant bowel obstruction. Taiwan Journal of Hospice Palliative Care, 15(2), 219–228.] doi:10.6537/TJHPC.2010.15(2).7

Lai, Y. H. (2016). Perspectives on cancer survivorship: Care and challenges. The Journal of Nursing Research, 24(2), 190–192. doi:10.1097/jnr.0000000000000163

林秀秀、郭憲華（2014）．照護一位大腸直腸癌併惡性腸阻塞護理人員之護理經驗．醫學與健康期刊，3（2），131–142。[Lin, S. S., & Kuo, H. H. (2014). A nursing experience of caring a nurse having colorectal cancer with malignant bowel obstruction. Journal of Medicine and Health, 3(2), 131–142.]