家庭系統對醫療自主性的影響－加護病房安寧共同照護模式照顧一位乳癌末期病人之經驗

Family System Influences Medical Autonomy -The Experience of Hospice Shared Care for the Breast Cancer Patient in End of Life

楊茵淇(Yin-Chi Yang) ； 詹雅如(Ya-Ju Chan)

《安寧療護雜誌》 21卷3期 (2016/11) Pp. 341-351

https://doi.org/10.6537/TJHPC.2016.21(3).8

摘要

本文是描述以安寧共同照護模式，協助一位入住加護病房的42 歲未婚乳癌末期病人及其家庭的經驗。筆者藉由2016 年5 月5 日至6 月4 日照護期間的臨床觀察及會談，確立病人身、心、靈層面問題為：1.癌症末期呼吸困難照護2.病人渴望與原生家庭修復連結，並在祝福中締結婚姻關係3.家庭系統無法因應癌末醫療決策及善終準備。筆者與原診療團隊共同協調照護目標，除提供腫瘤傷口照護外，同時藉藥物處置、精油按摩、舒適位姿、情緒支持來緩解病人呼吸困難症狀不適，並傾聽家人無奈及不捨以建立信任關係，過程中以家庭系統理論(family system theory)及華人家庭文化觀點評估家庭成員的角色功能及溝通型態。召開家庭會議，使家庭成員充分瞭解病人疾病程度後，引導家屬選擇更符合病人需求的善終目標，並協助病人展現醫療自主權以實現社會心理層面統整及靈性層面連結。

關鍵字

生命末期 ； 重症緩和療護 ； 家庭 ； 自主原則

並列摘要

This Case Report tries to focus on the experience of hospice shared care for a terminal breast cancer single patient and her family. Based on clinical visits and interviews, the subjective and objective data were collected from May 5 to June 4,2016.Her health problem is terminal cancer dyspnea. We coordinated with the team of intensive care unit, and used medication with comfort care to relieve the symptoms. Due to young age and family entanglements, their psychosocial and spiritual issues were the difficulty of consensus between patient and her families. We listened and empathized the helplessness and grief of the families, and assessed the roles,functions and communication patterns between family members in accordance with family system theory and traditional Chinese culture. Intended to provide physicalpsychosocial- spiritual care, we arranged family conference and explain the helpful choices of medical decisions , which meet the patient needs of good dying, such as accompany, family relationships ,self-realization. Our palliative care helped patient and families to express love and acceptance to each others ,encouraged patient to carry out her autonomy and realize the meanings of life and spirituality integrity .

並列關鍵字

end-of-life ； family ； palliative care ； the principle of respect for autonomy

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