照顧末期病患醫師之困境與轉變

The Difficulty and Change when Physicians Care Terminal Cancer Patients

方俊凱(Chun-Kai Fang) ； 賴明亮(Ming-Liang Lai) ； 呂欣芹(Hsin-Chin Lu) ； 李佩怡(Pei-Yi Li) ； 林明慧(Ming-Hwai Ling) ； 曾煥棠(Haunn-Tarng Tseng)

《安寧療護雜誌》 12卷4期 (2007/11) Pp. 369-384

https://doi.org/10.6537/TJHPC.2007.12(4).1

摘要

本研究旨在探討照顧末期病患醫師所遭遇之困難、成長需求、因應與轉變。採用海德格現象學取向的質性研究法，分層隨機和立意取樣27位照顧癌末病患的醫師爲研究對象，進行深度訪談。資料分析的方法參考Colaizzi (1978)的七個步驟，並使用ATLAS.ti 5.0套裝軟體進行資料分析。結果發現：1.照顧末期病患醫師的困難涵蓋五大層面如下：(1)醫病關係與溝通：如病情告知、安慰家屬等。(2)病患的照顧：包含對病患生理照顧的無力感和挫折感、懷疑自己提供靈性照顧的能力。(3)醫師自我照顧：如悲傷調適、意義挫折等。(4)醫療團隊：包含團對照護方向不一致、缺乏支持力量。(5)制度：如人力負擔、法律、健保、社會福利等。2.醫師的成長需求則包含：(1)醫病關係與溝通(2)靈性層面(3)自我照顧。3.醫師的因應方法：包含身體、心理、社會與信仰的調適。醫師的轉變可歸納爲行醫態度、生死觀、生活態度以及面對失落與悲傷四個層面。以上結果將可作爲建構醫師成長課程的依據。

關鍵字

醫師 ； 困難 ； 成長需求 ； 因應 ； 轉變

並列摘要

The aim of study had conferred with the difficulty, growth, coping and change when physicians care terminal cancer patients. A qualitative phenomenological approach based on Heidegger's existentialism was used to guide this study. Phenomenological approach is often used by stratified sampling and purposive sampling to research twenty-seven doctors in the fields of hospice palliative medicine receiving the in-depth interview. The method of analysis referred to the ”Colaizzi's seven steps” method of 1978 modified by Judith Thornton and Alan White and ATLAS. ti 5.0 software was further used to facilitate data coding and analysis. The research result had shown: 1. The five difficult aspects to physicians when caring terminal cancer patients are (1). The communication with patients or family: dilemma of announcing patients' condition or how to comfort the family. (2). Care for their patients: the frustration of treatment and disability of spiritual care. (3). Take care for themselves: physicians need to adjust the grief reaction for patients' death or the anxiety for the certainty of death. (4). Medical team: the imbalance of therapeutic team or physicians lack of company's support. (5). The system problems: overloading、 medical law、health insurance、social welfare etc. 2. Physicians' growth is including (1). The communication with patients and the family、(2). Spiritual care、(3). Take care of themselves 3. Cope with problems is adjusting themselves from physiology、psychology、society and faith. The four change aspects could carry out from the practice medicine daily、concept of life and death、the attitude to life and how to face the depression and grief. Above those results could develop the education courses of spiritual growth to help physicians overcome their existential distress.

並列關鍵字

physician ； difficulty ； growth ； coping ； change