某緩和醫療病房癌末病人住院時死亡恐懼之表現及轉機

Clinical Presentations and Mechanisms of Death Fear in Patients with Terminal Cancer on Admission at a Palliative Care Unit

陳慶餘(Ching-Yu Chen)

《安寧療護雜誌》 19卷2期 (2014/07) Pp. 125-137

https://doi.org/10.6537/TJHPC.2014.19(2).1

摘要

研究目的：了解癌末病人死亡恐懼、靈性境界與善終之情形。研究方法：針對2005年1月至2007年12月在台大醫院緩和醫療病房住院期間，接受臨床宗教師照顧完案記錄的回溯性研究。內容包含：基本資料、靈性境界、死亡恐懼臨床表現、死亡恐懼程度、善終指標分數等。透過小組討論的方式，將質性記錄資料轉譯為量性的數據，所做的整理分析。研究結果：在50名癌末病人中，58％是男性，平均年齡為58歲，原發部分以肝癌18％最多，80％有宗教信仰，平均存活期35.5天，76％在醫院死亡。死亡恐懼表現，以「失去努力方向的心理症狀」、「無名的害怕表現」及「失去勇氣去面對的作為」等表現最多。在死亡恐懼程度的相關變項中，僅靈性境界一項具顯著統計意義。結論：本研究支持先前發表死亡恐懼的論述，其機轉在於病人所持的生存法則，無法解決死亡問題，加上對未來的不確定性，產生不能接受死亡或逃避死亡的各種行為。

關鍵字

死亡恐懼 ； 安寧緩和醫療 ； 臨床佛教宗教師 ； 靈性境界

並列摘要

Purpose: To understand the fear of death, spirituality and good death in patients with terminal cancer. Method: A retrospective study of death fear in patients with terminal cancer was done at a palliative care unit of National Taiwan University Hospital. Data was collected from case report by Clinical Buddhist chaplains who took care of patients as other core team members during Jan 2005 to Dec 2007. The original descriptive clinical record included patient's basic demographic data, special forms of spirituality, clinical manifestations of death dear, various levels of death fear and good death score etc. The records were reviewed by research team members to reach a common consensus regarding degree of spirituality and death fear transferred from qualitative to quantitative data, Results: The basic demographic data was shown as follows: Total 50 patients, male 58%, mean age 58 years old, primary hepatoma (18%) the most diagnosis, 80% with one religion belief, mean survival time 35.5 days and 76% death at hospital. The common three clinical manifestations of death fear were: psychologic symptoms of uncertainty to make efforts; anomalous fear presentations; loss of thrive to face inevitable death. Among various items related to death fear score, the degree of spiritual disturbance was the only significant variable before intervention. Conclusion: The results supported the previous death fear mechanism attributed from that the inner life strength embraced by people unable to overcome the issue of death. For patients, especially terminal patients, long-time belief in those survival rules plus uncertainty of prognosis and worry about the worst outcome results in various behaviors of unacceptance and avoidance in the face of death.

並列關鍵字

fear of death ； hospice palliative care ； clinical Buddhist chaplain ； spirituality