癌症末期病患照顧者之喪親後憂鬱歷程及其影響因素

Trajectory and Influencing Factors of Depression-Symptoms of Bereaved Family Caregivers of Terminally Ill Cancer Patients

郭素青(Su-Ching Kuo) ； 蔡洧沂(Wei-I Tsai) ； 唐秀治(Siew-Tzuh Tang)

《腫瘤護理雜誌》 14卷增訂刊 (2014/12) Pp. 31-41

https://doi.org/10.3966/168395442014121403003

摘要

癌症末期病患之照顧者處於高負荷的狀態，又得面臨即將喪失親人的哀慟，對照顧者身、心是極大煎熬，甚且可延長至喪親後，隨著喪親時間增加，喪親者通常能慢慢調適返回正常生活狀態，但有部分照顧者沉浸於強烈的哀傷憂鬱情緒中無法回復，影響原本的生活型態，漸漸演變成不正常的哀傷反應，甚至引起重度憂鬱症或複雜性哀傷。本文以文獻回顧方式，統合實證研究結果，以了解癌症末期病患之照顧者喪親後憂鬱歷程及影響因素。實證結果顯示照顧者的憂鬱歷程隨著喪親時間增加，憂鬱程度則會逐漸下降，影響因素包括：若病患之死亡為預期性死亡、照顧者對病患死亡有較佳的準備度、良好的社會支持，則喪親後憂鬱程度會較低；但照顧者喪親前有較高的憂鬱程度和較差的身體狀況，其喪親後憂鬱程度則會較高。護理人員應於提供癌症病患末期照顧的過程中，加強對有較高憂鬱程度、身體狀況較差、欠缺良好社會支持的照顧者，進行適當的評估，盡早提供適當的護理措施，促進對病患死亡的準備及哀傷的表達，以協助喪親者盡快重新回歸正常的生活。

關鍵字

癌症末期病患 ； 照顧者 ； 喪親 ； 憂鬱歷程

並列摘要

Family caregivers of dying cancer patients shoulder heavy caregiving burdens. In addition to the pressure of caring for terminally ill cancer patients, caregivers mourn the forthcoming loss of their relative, which can create great torment on their body and mind. Such suffering can extend into bereavement. Most bereaved caregivers gradually adjust to the loss. However, some caregivers cannot cope with their relative's death and develop major depressive disorders or complicated grief during bereavement. The purposes of this study were to review the trajectory and influencing factors of depression symptoms of bereaved caregivers of chronically ill cancer patients. Literature review indicated that caregivers' depression symptoms peaks at 1-2 month and decreases significantly post-bereavement. Bereaved caregivers experience a lower level of depression symptoms if the death is expected, if they are well prepared for the forthcoming death of their loved one, and if they have greater social support. Caregivers report a higher level of depression symptoms after bereavement if they suffer a higher level of depression symptoms before the patient's death and they have a poor physical health condition. Nurses should increase their awareness of the factors influencing caregivers' depression symptoms before the patient's death and pay special attention to caregivers who have inadequate social support, poorer health, or are suffering from a higher level of depression symptoms. Appropriate care before and after the patient's death is needed to facilitate caregivers' psychological adjustment to the loss of their relative and allow the bereaved to return more rapidly to their normal lives.

並列關鍵字

depressive-symptom trajectory ； bereavement ； family caregiver ； terminally Ill cancer patient