病者的世界：癌末患者心理生活經驗探索

臨終處境下的癌末患者，死亡對其意涵是關乎自身的獨特事件，在死亡無可比擬的急迫經驗下，身、心、靈的壓力是難以言銓的。本研究主要是經由癌末患者的敘說，探究癌末處境下受苦的存有，透過敘事直指敘事者的存在與其對自己所經驗之世界的詮釋，重建癌末患者置身邊界處境下的複雜的心理社會經驗。本研究採立意取樣，研究對象為南部某醫學中心安寧緩和醫療（或居家安寧）之癌末患者。共有四位患者參與，患者的罹病經驗為六個月至九年。研究期間每位參與者的訪談次數為一次到九次不等，平均每位參與者接受4.6次的訪談。訪談後，將資料謄寫轉錄，以存在現象學方法進行結果分析。主要結果顯示，嚴重的疾病摧毀癌末患者對時間存在的認知，而潛在威脅其自身的「本體安全感」。對於癌末患者而言，置身於疾病的苦痛和無法防範的死亡焦慮威脅下，除了生命、財產、親友及對世界可預測感與安全感的整體失落外，也衝擊著患者的認同意識。臨終伴病和疾病敘說對癌末患者提供了一種療癒的可能。透過他人的在場以及與他人的連結，患者得以在死亡的孤寂荒原裡感受到一種溫暖的歸屬感，而這是對臨終者重要的支撐力量，這種關係共在使臨終者得以在對抗死亡的無意義中，重構對世界的意義和安全感。進言之，敘說作為一種關係共在的橋樑，透過反覆的敘說，患者在詮釋自我中，重組了遭逢疾病而斷裂的心理生活世界，進而認同新自我。照顧者的同體一心伴行亦得以分擔患者存在的掛慮和受苦體驗，提供恰當的存在安適，使癌末患者獲得更好的臨終關懷品質。

關鍵字

癌末患者；存有；疾病經驗；敘說；認同

並列摘要

Death is a more than personal event for the dying patients who had suffered great physical complaint and emotional fatigue under the crucial boundary situation. The research was designed to reveal the world from the eyes of patients through the patients’ narratives based on the existence of the individual from being-in-the-world towards inward turning. Through the biographical self-narratives of patients and the way they indicated the unique existence and their perception of experience to the life-world, the research was intended to reconstruct the patients’ complicated psycho-social experiences in the dying boundary situation. Purposive sampling was adopted in a certain hospice palliative care medical center located at the southern Taiwan. Four patients participated in the study, the range of the illness duration is from 6 month to 9 years. During the data collection period, each subject were interviewed about one to nine times and about four to six times in average. Then, the narratives were coded and transformed. The data was interpreted and analyzed by the existential hermeneutics methods. The result was pointed that the severe disease does not only affect the perception of temporality for the dying patients but also potentially destroy their sense of ontological security. For the patients exposing themselves to the sufferings of disease and unavoidable death anxiety, they faced a great loss of the whole world, such as life, property, family, friends, predictable sense of world and sense of security. Furthermore, the patient’s identity was disrupted by the terminal disease. The patients felt the strong and warm belongingness in a deserted world when in connection with the other, it is an important support resource to enrich their life experiences. And this kind of coexisted relationship was functioned to reconstruct the life meaning and sense of security in the being-in-the- world. Finally, temporality, transcendence, meaning and meaninglessness, life, death and anxiety, destiny, responsibility and freedom are the important themes for the dying patients. It is worthy to be discussed furthermore in the future study.