臨床工作者對癌末患者照護需求的理解與回應

在生命末期照護(end-of-life care, EOLC)期間，病患與臨床工作者的關係會變得特別敏感，尤其處於末期症狀的照護，常出現自覺負擔的心理現象。本文藉由臨床工作者實務經驗來探索如何建立和維持臨床工作者與病患之間的信賴關係。從臨床工作者對癌末病患需求的理解與回應深入探討，由深度訪談的質性研究方法進行資料收集，遵守告知同意、不傷害與匿名保密等倫理原則，以立意取樣方式邀請六家醫院的臨床工作者為研究對象，共計37 人。臨床工作者對癌末病患後期疼痛整合照護轉化為接受EOLC 之需求，歸納下三項：從診斷檢查到病患角色的承擔，對臨床工作者實際照護需求高；病患與臨床工作者之間的溝通需求具有多元性；依賴性的病患角色與問題解決的策略整合之支持力量。研究結果如下：一、EOLC 服務前，強化整合性且符合人性化的照顧服務。二、EOLC 服務後，有效運用溝通技巧提供釋疑。三、臨床工作者團隊表現，建立專業分工與臨床品質之默契。本文得到以下四個方向的結論：自我成長的價值、情緒反應的撫慰、生理狀況的調節、醫療團隊的合作。以臨床工作者共同對於病患需求進行理解與回應達共創效應之目的。

關鍵字

生命末期照護；疼痛整合照護；癌末病患；臨床工作者

並列摘要

When patients are diagnosed as entering the end of life care (EOLC) stage, their relationship with clinical workers becomes ＂especially sensitive,＂ and the workers often report feeling an understanding of and response to their need when they attend the terminally ill. By exploring clinical workers' experience of providing EOLC, this study aims to develop approaches that help to build and maintain trust between the EOLC practitioners and the patients. Clinical workers’ SPB associated with looking after EOLC patients was discussed on the basis of stages of illness and medical care. Next, an in-depth interview was conducted under the ethical principles of informed consent, non-maleficence, anonymity and confidentiality, and purposive sampling was used to enroll 37 clinical workers from 6 hospitals. Based on the participants’ clinical experience, EOLC patients’ needs were summarized in three aspects. First, when a patient is diagnosed with a terminal illness, the role of the clinical worker’s service becomes increasingly important for the patient. Second, the terminally ill patient needs multifaceted support from the clinical worker. Third, strategic cooperation between clinical workers should be duly undertaken to meet the growing needs of dying patients. Three practical implications drawn from the integrated pain care (IPC) findings are: 1. Before EOLC is administered, this caring service should be better tailored to the individual needs of patients; 2. After EOLC is administered, the clinical worker should effectively address any questions raised by the patient and his or her family members, and thus establish and maintain a satisfactory level of the clinical quality of EOLC. The conclusions of this study were as follows: the value of self-growth, the comfort of emotional response, the regulation of physiological status, and the cooperation of medical teams. The assignment of EOLC tasks should be made on the basis of clinical workers’ respective areas of expertise.