探討癌症治療後合併淋巴水腫術後病人之生活經驗

To explore the life experience of patients post cancer treatment with lymphedema

王皇瓔(Huang-Ying Wang)

指導教授 ： 胡 蓮 珍

共同指導教授 ： 張 長 正(Chang-Cheng Chang)

中山醫學大學/醫學院/護理學系/碩士(2022年)

https://doi.org/10.6834/csmu202200070

摘要

背景: 罹患癌症意味著面臨一連串的決策與治療、照顧、身體變化與心理調適等議題，而淋巴水腫為常見癌症治療後的合併症，會導致生理、心理和社會功能等影響。病人癌症治療後罹患淋巴水腫，且再次手術治療會造成很大衝擊。過去研究大都以量性研究探討淋巴水腫的發生率、預測因子及相關因素分析，較少描述病人的主觀經驗，故本研究以質性研究了解淋巴水腫病人的生活經驗。
目的：本研究主旨在探討癌症治療後合併淋巴水腫術後病人的生活經驗 。
方法: 本研究為現象學研究，以立意取樣，收集2020年10月至2022年05月在中部某醫學中心整形外科門診及病房之癌症術後合併淋巴水腫的病人。採一對一深入訪談方式，以開放式問句引導參與者說出癌症治療後合併淋巴水腫術後的歷程、感受，經參與者同意下訪談過程全程錄音，訪談後謄寫為行為過程逐字稿，以內容分析法，歸類成病人經驗脈絡的主題。
結果: 研究結果呈現四個主題及九個次主題。分別為(一)逆流而上
，奮力對抗：為疾病找出合理解釋、鍥而不捨抵抗病魔；(二)永不放棄，奮力更生：層出不窮的疾病症狀、不屈不撓的追尋健康；(三)歪瓜裂棗，重建人生：身體心像改變的卑微、親密家人幽谷伴行、浴火重生，生命意義再建構；(四)治療路漫漫，上下而求索：期待雙向醫病溝通與關懷、期望醫療保健再精進。
結論: 癌症治療後合併淋巴水腫術後的漫長歷程，在治療過程中淋巴水腫會不斷的重複發生困擾參與者(病人)，造成的多重困擾需不斷求醫甚至多次住院治療，對於工作及日常活動生活、社會心理都產生影響。經過時間的磨練，家人陪伴與支持，參與者(病人)除了學習與疾病共處，心靈上也因宗教力量讓自己可以正視疾病，對生命意義重新定義。醫護人員除了提供醫療照顧，應落實全人照顧，與病人建立正向的治療性關係，提供醫病共享決策，適時關懷及同理，以提昇照護品質。

關鍵字

癌症治療 ； 淋巴水腫 ； 淋巴水腫手術 ； 生活經驗

並列摘要

Background: Cancer suffers means facing a series of issues such as decision making and treatment, care, physical changes, and psychological adjustment. Lymphedema is a common comorbidity after cancer treatment, leading to physical, psychological, and social functions. The patient develops lymphedema after cancer treatment and reoperation can be very shocking. In the past, most research used quantitative research to explore the incidence, predictors, and related factors of lymphedema and rarely described subjective experiences of patients. Therefore, this study used qualitative research to understand the life experience of patients with lymphedema.
Objective: The purpose of this study was to explore the life experience of patients post cancer treatment with lymphedema.
Method: This research is a phenomenological study, with intentional sampling to collect lymphedema patients after cancer surgery in the plastic surgery clinic and the ward of a medical center in Taichung from October 2020 to May 2022. In-depth one-on-one interviews were used, and open-ended questions were used to guide participants in describing their experience and feelings after cancer treatment combined with lymphedema. With the consent of the participants, the entire interview process was recorded and transcribed as a verbal transcript of the behavior process after the interview, using content analysis, to categorize the themes in the context of the experience of the patients.
Results: The findings presented four themes and nine subthemes.
Respectively: (1) Go against the current and fight hard: find a reasonable explanation for the disease, and perseverance to resist the disease; (2) Never give up and strive to rehabilitate: endless disease symptoms, the indomitable pursuit of health; (3) Ugly surface, rebuild life: the humble change of body image, the companionship of close family members, rebirth from ashes, reconstruction of the meaning of life; (4) The road to treatment is long and the search for better quality of medical care: looking forward to mutual medical communication and care, and hope that medical care will be further improved.
Conclusion: After cancer treatment combined with lymphedema after surgery is a long course. During the treatment process, lymphedema will continue to recur and inconvenience the patient. Multiple problems caused require continuous medical treatment and even multiple hospitalizations. Through time and family companionship and support, the patient not only learns to live with the disease, but also because of the religious power, he can face the disease and redefine the meaning of life. In addition to providing medical care, the medical professional must implement whole-person care, establish a positive therapeutic relationship with patients, provide shared decision making between physicians and patients, timely care, and empathy, to improve the quality of care.

並列關鍵字

Cancer Treatment ； Lymphedema ； Lymphedema Surgery ； Life experience

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