- 學位論文
末期癌症病人之緩和鎮靜治療：家屬顧慮及對家屬哀傷程度的影響
Palliative Sedation for Terminally Ill Patients With Cancer: Family Concerns and Levels of Grief
摘要
使用緩和鎮靜來緩解癌症末期病人之無法忍受的痛苦及執拗的症狀，其使用情形已有逐漸增加之趨勢，其目的是讓病人在臨終前症狀得以緩解並獲得舒適。但末期病人的家屬在做此治療決策時，會面臨許多的困擾，甚至於病人過世後，家屬因擔心緩和鎮靜可能加速病人死亡或覺得可能還有其它緩解症狀的方法，因而可能影響其哀傷經驗，然而過去這方面的研究相當少。故此研究目的是探討末期癌症病人使用緩和鎮靜治療，家屬之顧慮及對家屬哀傷程度之影響。本研究採描述性相關性研究設計，以方便取樣於台北某醫學中心之安寧病房進行，研究對象選取為：末期癌症病人之家屬，以結構式問卷進行訪談，於病人使用緩和鎮靜治療前完成基本資料表，若病人有使用緩和鎮靜治療者，則完成家屬對於緩和鎮靜治療之顧慮問卷，使用緩和鎮靜治療後完成緩和鎮靜使用情形問卷、家屬決策過程問卷、家屬對於緩和鎮靜治療之顧慮問卷，並於喪親後一個月以電話訪談方式完成所有家屬之哀傷程度量表。為保護個案隱私，研究者取得之資料係以匿名及編號方式處理，以SPSS 16.0套裝統計軟體進行資料分析。結果發現：全部有81位受試者其中有使用緩和鎮靜治療者有41位，無使用緩和鎮靜治療者有40位，有使用緩和鎮靜治療其哀傷程度反應比無使用者較高，國內使用緩和鎮靜治療至死亡平均天數約為10.83天早於國外，且以需要時使用為主，與國外多以常規性使用為主不同，由於使用時機較早，故家屬覺得可能還有其他緩解此症狀的方法、感覺她/他是被強迫睡著、希望能有機會與全體家屬一起討論及無法擔負起做此決定的責任等之顧慮。期望藉此結果能協助醫療人員了解，與家屬提早溝通，讓家屬及病人能有更多的時間考慮及與其他家人共同討論，以期讓病人能在最適宜的時間點得到最佳的症狀控制。
並列摘要
It is more popular to using the palliative sedation therapy to control intractable and refractory symptoms in terminally cancer ill patients. But it may cause profound family distress, even effect their grief. The purpose of this study is to determine the family concerns and levels of grief in palliative sedation. The survey of the families of cancer patients who received palliative sedation at palliative care unit in one of the medical center in Taipei. The questionnaire survey assessed 81 bereaved families, 41 families that the patients were received the palliative sedation therapy and 40 were not. The result of this study was that there was significant in the patients who were received the palliative sedation therapy that the families the levels of grief was higher than not used. Since using the palliative sedation therapy to death was 10.83 days that was longer than foreign. The families were think that is too early to let patients received the palliative sedation therapy. The family concerns were there might be other way for symptom relief, feeling as though the patients was forced to sleep and wish there had been a chance for the entire family to discuss. We hope that the medical staff can provide information about palliative sedation therapy to families and let them have enough time to discuss. We must fine the most appropriate time to sedate the imminently dying with refractory symptoms.