思覺失調症患者的復健服務決策：患者與家屬陪伴者的觀點

精神疾病患者照顧是近年來受到社會福利界注意的服務議題之一，「老人照顧精神障礙老人」之壓力與風險更是受到社政單位重視。本研究以思覺失調症病人及其家屬陪伴者為訪談對象，了解雙方在最近一次的服務選擇經驗中，其復健目標、雙方對此次服務決策的看法，及思覺失調症病人自主決定的看法，進行訪談。此研究希望能啟發福利服務輸送或政策制定者，注重思覺失調症病人的意見和自主決定的觀點。本研究以質性研究之對偶訪談法為資料蒐集方法，訪談6位35至45歲思覺失調症病人及4位家屬陪伴者（4對成對，共計10位受訪者），了解雙方在最近一次的服務決定經驗及各自的看法。研究者針對思覺失調症病人及其家屬雙方個別聯合進行1~2次訪談，訪談經研究對象同意後錄音、撰打逐字稿，及確保資料保密，並遵守我國社會工作研究倫理守則等相關倫理規範。研究分析以復元成果、自我期待和他人期待之落差、自主性為分析主題，兼討論其他影響決策之因素。研究結果發現思覺失調症病人個人的復元成果，的確影響個人行使其自主決定。研究分析結果也看見思覺失調症病人和其家屬陪伴者對可自主決定範圍的差異，也在服務決定上有不同的看法。本研究建議如下：1. 無論是精神醫療專業人員、社區復健服務、個案管理服務，甚至非正式支持系統，對於思覺失調症病人的服務，長期陪伴與支持仍是較好的策略，較能看見其復元成果。2. 個人達到的復元成果有助於思覺失調症病人社群的自我充權，而自控感、獨立自主、自主／自助進而助人等價值便是復元成果呈現的面向之一。3. 旁人應該給思覺失調症病人在生活中多做決策的機會。專業人員在復健計畫或治療計畫的協商上，應保持一定的開放性與緊密溝通，以兼顧思覺失調症病人自主性和其健康福祉。4. 政策制定上應以精神疾病去污名為目標。

關鍵字

思覺失調症；自主；服務選擇；決策；雙老家庭；對偶訪談

並列摘要

Social and rehabilitation services for patients with mental illness has gained increasing attentions in social work literature over the past decade, with “aging of family caregivers and patients with mental illness” emerging as one of the pressing topics that concern both social work practitioners and policy makers alike. This study aims to investigate the perspectives about the decision-making on service use between mid-aged individuals with schizophrenia (MIS) and their aging family caregivers. More specifically, this study addresses the decision-making on the most recent service use, their rehabilitation goals, and MIS’s involvement in decision-making in the relational context with their aging family caregivers. This research hopes to provide additional information to service providers or policy makers, so that they can better appreciate the voices of MIS and their autonomy in making decisions. This study adopted a qualitative research approach, and conducted semi-structured, dyadic interviews with 6 MIS and 4 family caregivers (including 4 MIS-family caregiver dyads), using snowball sampling methods. The 6 participating MIS, aged between 35-45 years old, and 4 main family caregivers who were all 60 year-old and above, shared their latest experiences of service use/transitions and their opinions. The researcher first conducted joint dyadic interviews with MIS and their family caregivers, and then conducted 1-2 additional interviews separately with MIS and family caregivers. The researcher fully complied with the social work research ethics: the researcher obtained full informed consents before conducting interviews and recording during interviews, and ensured confidentiality of the interviews and participants. The researcher then applied thematic analysis on the transcriptions of the interviews. The analysis yielded several themes, including recovery outcomes, the differences in recovery expectations between MIS and their family caregivers, autonomy, and factors that influenced decision-making on services use. This study found that recovery outcomes can impact MIS on exercising their autonomy in making decisions. Additionally, differences between MIS and their family caregivers in the degrees of self-determination MIS can enjoy lead to different opinions over decision-making on services use. The implications of this study include: First, for medical professionals, rehabilitation workers, mental health case managers, and informal supporters, provide longer support to MIS may result in better recovery outcomes. Second, MIS’s recovery outcomes can in turn help MIS further achieve self-empowerment, and value their self-control, autonomy, self-help, and mutual help, which are also integral components of recovery outcomes. Third, MIS should receive more opportunities to make decisions autonomically. Open and efficient communications are good strategies to ensure autonomy and wellness among MIS.