運用共享決策模式照護一位癌症末期合併呼吸困難病人之護理經驗

Nursing experience involving the use of the shared decision-making model to care for a patient with terminal cancer and dyspnea

林嘉雯(Chia-Wen Lin) ； 周碧玲(Pi-Ling Chou)

《安寧療護雜誌》 26卷2期 (2022/03) Pp. 178-190

https://doi.org/10.6537/TJHPC.202203_26(2).06

摘要

癌症末期病人合併呼吸困難的導因非常廣泛與困難處置，常因此症狀不適影響病人生活品質，尤其在餘命時間不長時，讓病人或家屬常常面臨到死亡焦慮等，如何做出對病人與家屬最佳醫療決策，是非常重要與困難。本文描述一位食道癌末期合併肋膜積水的病人，呼吸困難症狀時，家屬對於醫療處置出現意見衝突、家屬面對疾病惡化產生死亡焦慮，如何在極短時間做出對病人與家屬最佳醫療決策，以達到病人善終，家屬善生的平衡。筆者運用共享決策概念，藉由團隊合作引導家屬各自提出自己的期待，藉由病況說明、溝通、討論，團隊提供首要醫療策略選項及抉擇，採非侵入性治療來緩解病人呼吸困難症狀，善用藥物、輔助性治療，讓病人症狀上安適；並家屬協助其完成臨終照護，讓病人獲得善終、家屬得到善生。

關鍵字

共享決策 ； 癌末 ； 呼吸困難

並列摘要

The causes of dyspnea in patients with terminal cancer are diverse and difficult to treat. As a result, patients' quality of life is often compromised. This is especially true when the patients' days are numbered, causing patients and their family members to experience anxiety about death. Accordingly, making the optimal medical decision for both the patients and their family members is a difficulty but extremely crucial matter. This study described the situation in which family members had differing opinions towards the medical treatment for dyspnea in a patient who had terminal esophageal cancer and pleural effusion. Seeing that the patient's condition deteriorated, the family members' anxiety about death increased. Only by making the optimal medical decision for both the patients and their family members within a short period of time can patients achieve a good death and their family members adopt a positive attitude towards life. By applying the concept of shared decision-making, the research team of this study used teamwork to guide the family members to voice their respective expectations. After description, communication, and discussion of the patient's condition, the research team provided the primary medical strategies and options. Eventually, a consensus was reached to alleviate the patient's dyspnea and improve patient comfort by applying a non-invasive treatment along with proper medications and adjuvant therapy. Through the assistance of the research team, the family members assisted with the arrangement of hospice care for the patient to achieve a good death, and the family members adopted a positive attitude towards life.

並列關鍵字

shared decision-making ； terminal cancer ； dyspnea

參考文獻

謝慧觀、林蕙鈴。緩和照護中伴隨呼吸 困難病人的處置。呼吸治療 2014；13 （22）：23-33。

陳如意。從共享決策 SDM 談落實癌症 病人的善終。腫瘤護理雜誌 2017；17： 27-37。

李思潔、彭仁奎、黃獻樑、蔡兆勳。緩和醫療之醫病共享決策。台灣醫學2021；25（2）：262-7。

陳昱芬、黃惠美、陳孟君、徐金菊、張碧華、徐倩儀、張美玉。建立癌症病人呼吸困難臨床照護指引。榮總護理 2014；32（3）：256-76。

黃詩凌、賴維淑、方素瓔。運用風扇緩 解呼吸困難—系統性文獻回顧與臨床 應用。護理雜誌 2018；65（4）：84-93。