肝臟移植病人及其家庭面對疾病與生活適應歷程之探討

末期肝病為不可逆性之疾病，當疾病進展至無法治療，透過成功的肝臟移植手術能延續病人生命。疾病影響的不只是病人，亦包含整個家庭，肝臟移植術後將面臨其他不同層面的健康問題，故病人及其家庭在罹病時所遭遇的所有問題，也並非是術後即可以完全獲得解決。醫療的目標應包括對生活品質的提升，病人及其家庭對疾病及生活的適應能力是醫療團隊所需要關注的層面。本研究採立意取樣，運用質性方式進行，訪談五位肝臟移植病人及五位肝臟移植病人家屬，透過對肝臟移植者家庭疾病及生活經驗之了解，分析其適應歷程中的困境及力量。透過受訪者之經驗，影響肝臟移植家庭適應歷程之阻力為1.疾病加劇及死亡陰影的身心威脅；2.角色責任的翻轉及失衡；3.家庭生活秩序的混亂。助力為1.積極正向的生活態度；2.適宜的家庭互動關係；3.適時多元的社會支持。依研究結果提出之建議為1.建立以家庭為主體的器官移植社會工作服務；2.強化醫務社會工作者之處遇面向；3.規劃連續性的關懷服務。

關鍵字

肝臟移植；疾病與生活適應；器官移植社會工作

並列摘要

Terminal liver cancer is irreversible. When the disease reaches the stage of incurability, the patient's life can be sustained through a successful liver transplant. Diseases affect not only the patient but also the entire family. After the liver transplant, new health issues will arise, and an operation doesn't exactly solve all the problems that patients and their families are facing. The goal of medical care should include the improvement of quality of life; therefore, the medical team needs to care about how the patients and their families adapt to the post-surgery life. In this study, we used the purposive sampling and the qualitative research method in the interviews of five liver transplant patients and five family members of liver transplant patients. The difficulties and strengths in their adaptation process were analyzed through understanding their post-operation life experience. The study found that t the resistance to the adaptation process of the liver transplant family is: physical/psychological threat from possible aggravation of disease or death, the reversal and imbalance of family roles and responsibilities, and disruptions in the routines of daily life. Power is: positive attitude towards life, proper interactions among family members, and diverse and timely social support. Recommendations based on the study results are: establishing family-centered in organ transplant social work service, Strengthening the treatment of medical social workers, and planning continuity care services.