晚期癌症患者的關係流變經驗初探

隨著醫學進步，晚期癌症患者的存活率及存活時間不斷延長，然而死亡即使延後仍會到來，半數以上患者仍會在幾年內離世，晚期癌症患者長久處於與死亡共活的閾限處境，從社會位置與角色中掉落進入一種非此亦非彼的中間地帶，既要面對死亡的臨近性，同時亦仍活生生地活於關係之中，經驗著與他人關係的不斷重新形構與轉變。本研究目的探究晚期癌症患者在面對死亡臨近的處境下，與周遭重要他人的關係轉變歷程。研究採立意取向，以東部某教學醫院病房之第三期與第四期癌症病患為研究對象，總共訪談六位患者，每位參與者分別進行1-3次深度訪談，每次訪談約60-120分鐘，訪談資料轉錄為逐字稿以後，以現象學心理學分析方法，進行資料分析與再書寫。研究結果發現，（一）晚期癌症患者與周遭他人的關係呈現閾限性的關係樣貌，（二）患者經驗到倫理關係的內涵轉變，包括倫理絆的認出與宿緣邊界的消融、以及倫理形式的轉變，（三）患者對周遭他人的牽掛具有雙重時間性，從線性的有限時間中向已不在的未來時間綿延。綜合討論部分，本研究亦重新勾劃晚期癌症患者時間性體驗與關係情感間相互勾連的經驗，呈顯病者如何在時空穿梭中帶出時間與關係情感的流變。並據此重新探討臨終心理質變中「社會期」的理解，本研究認為晚期癌症患者從生向死，並非為一種單向的掉落過程，而是一種共現往返的存有狀態呈現。最後，研究也指出在社會位置與角色的剝除之下，存有原初地與他者共在的樣貌，呈顯在族群、文化或信仰的根源之中，是跨越時空環境限制的原初連結。

關鍵字

晚期癌症；閾限性；關係；時間性

並列摘要

Along with the progression of medical science, the survival rate and survival time of advanced cancer patients have been prolonged. Although the advent of death is delayed, more than half of the patients will still die within a few years. Advanced cancer patients are living in the liminality situation of living with dying for long, falling from social position and role into a kind of middle ground between here and there, facing the imminence of death while still living alive in the relationship. At the same time, experiencing the constant reconfiguration and transformation of relationships with others. The purpose of this study was to investigate the transitional process of relationships with advanced cancer patients and their significant others in the situation of living with dying. The research adopts an idea-oriented approach, taking the third and fourth stage cancer patients in a ward of a teaching hospital in the east of Taiwan as the research object. A total of six patients were interviewed, and each participant were conducted 1-3 in-depth interviews, each interview lasted about 60 -120 minutes. After the interview, the data were transcribed into verbatim transcripts, be analyzed and rewritten using the phenomenological psychological analysis method. The results of the study found that (1)the relationship between advanced cancer patients and others showed a liminal relationship appearance, (2)the patients experienced a change in the connotation of ethical relationships, including the recognition of ethical bonds and the ablation of the boundary of Su-Yuan(宿緣), and the transformation of the ethical form, (3)the patient's care for others shows a dual temporality, extending from a linear limited time to a future time that the patient is no longer alive. Finally, this study also redraws the becoming experience of the connection between temporal experience and relational affect in advanced cancer patients, showing how patients bring out the flow of time and relational affect in the travel of time and space. Based on this, the understanding of the "social stage" in the qualitative change of the dying mind is re-examined. This study believes that the transition from life to death in advanced cancer patients is not a one-way dropping process, but a co-occurrence and round-trip existence state. Finally, the study also pointed out that under the stripping of social position and role, the original appearance of being with the other is manifested in the roots of ethnic groups, cultures or beliefs, and it is the original connection that transcends the limitations of time and space environment.