晚期肺癌病患在治療期間的靈性困擾與需求之探討

Exploration in Spiritual Distress and Spiritual Needs of the Patients with Advanced Lung Cancer during Therapeutic Transition

蕭思美(Szu-Mei Hsiao)

指導教授 ： 施富金

國立臺灣大學/醫學院/護理學研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.01806

摘要

1982年至今，癌症一直高居台灣十大死因之首位。其中肺癌在女性排名則第一，在男性癌症死因中排名第二。晚期肺癌病患在存活期間常抱怨其靈性困擾未受重視，臨床護理人員亦對此類病患之靈性需求所知有限，本研究目的在瞭解晚期肺癌病患在治療期間的靈性困擾及靈性需求、獲得或未獲得靈性需求之過程做深入探討。本研究採探索性質性研究法，在北部某一醫學中心之腫瘤科病房，以立意取樣法並以參與式觀察法及深入性訪談收集資料。本研究共訪談19位晚期肺癌病患，共計38次，平均每位病患訪談兩次。訪談資料以質性內容分析法及描述性統計法分析。
個案年齡介於35-81歲，只有一位男性未婚；47%國小畢業，84%有宗教信仰，以佛教居多（32%）。39%病患已知罹病時間在半年內，63%病患在住院期間有固定照顧者。
研究結果發現，接受治療之晚期肺癌病患之靈性需求含：協助其接受患病真相並爭取存活希望、協助個人建立清楚的人生觀、價值與信念體系、滿足個人所需的人間愛、建立與上天（神）和好關係並獲福氣、協助其平安面對死亡。
而接受治療之晚期肺癌病患之靈性困擾含：個人的人生觀、價值與信念體系受到干擾、個人所感受的人間愛受到干擾、個人與神的關係受到干擾、及害怕面對死亡。本研究訪談時僅一位個案，沒有靈性困擾。
晚期肺癌病患之靈性需求獲得滿足，涉及二階段式或三階段式之震驚與調適期。三階段式靈性需求獲滿足含，第一階段震驚與第一次調適期，第二階段為靈性困擾期，及第三階段再次調適及靈性滿足期。二階段式靈性需求獲滿足為，第一階段震驚與第一次調適期，及第二階段再次調適及靈性滿足期。在靈性需求獲得滿足後，仍可因生命價值體系支持不足，及持續身體健康困擾，再造成靈性需求無法獲得滿足。
晚期肺癌病患之靈性需求未獲滿足涉及三階段，第一階段震驚與第一次調適期，第二階段靈性困擾期，第三階段再次調適及靈性混亂期。其它影響靈性需求未獲滿足之因素包括：（1）在家屬方面：因害怕病患無法接受患病真相及面對死亡、或病患因病情需要保護隔離，無法提供靈性支持。（2）在個案方面：不願意談、或因醫療處置或生理障礙無法口語表達其靈性需求、或因對上天（神）不相信或沒信心，阻礙其靈性需求之滿足。（3）在醫護人員方面：因怕觸及病患隱私、或宗教觀不同、缺乏相關靈性照護知識、工作時間或自我準備不足，而無法滿足病患靈性需求。
本研究結果有助於臨床醫護人員早期發現有靈性困擾之病患，並正確評估其靈性需求，主動結合親友、醫療團隊、及宗教信仰支持，以提供病患及家屬所期待之全人護理。對學校護理教育，建議能開設生死學、靈性護理、安寧緩和之相關課程，以增加護理人員靈性照顧之知識與技能。本研究可作為日後發展量性問卷之基礎，及日後發展本土化癌症病患照護模式之藍本。

關鍵字

靈性困擾 ； 晚期肺癌 ； 靈性安適 ； 質性研究 ； 靈性需求

並列摘要

Cancer has been the leading cause of death in Taiwan since 1982. Currently, lung cancer is the first cause of death for female and the second one for male cancer patients. However, many advanced lung cancer patients complained that their spiritual distress was not considered important or well dealt with. Moreover, most nursing staff didn’t know much about spiritual needs of such patients. Therefore, the main purpose of this exploratory qualitative study was to explore spiritual distress and spiritual needs of the patients with advanced lung cancer during their therapeutic transition and their development stage of unfulfilled and fulfilled spiritual needs. Purpose sampling was adopted to invite 19 advanced lung cancer patients from the oncology floor of a medical center in the north of Taiwan. Participant observation and in-depth face-to-face interview were employed to collect data. The total number of interview times was thirty-eight, averagely two times for each participant. The interview data were analyzed with descriptive analysis and qualitative content analysis.
The participants were aged between 38 and 81 and all but one male were married. Most of them (47%) had no education beyond elementary school. About 84% of the participants had a religious belief and most participants (32%) were Buddhists. Furthermore, 39% of the participants were informed of lung cancer within half a year. Most participants (63%) had fixed primary care givers in the hospital.
The results showed that the spiritual needs of the participants with advanced lung cancer during therapeutic transition were: (a) helping them accept their doctors’ diagnoses and increase their survival hope, (b) helping them establish concrete outlooks on life, value, and belief, (c) helping them feel fulfilled with love, (d) helping them build good relationships with God, and (e) helping them face death peacefully.
The results also indicated that the spiritual distress of the advanced lung cancer patients during therapeutic transition were derived from (a) a disturbance in the outlooks on life, value, and belief, (b) a disturbance in human love, (c) a disturbance in the relationship with God, and (d) fear of facing death. Only one participant didn’t have spiritual distress.
The fulfillment of the advanced lung cancer patients’ spiritual needs was involved with two-staged or three staged shock and adaptation. The three-staged fulfillment of spiritual needs included: (Stage 1) shock and initial adaptation, (Stage 2) spiritual distress, and (Stage 3) re-adaptation and spiritual satisfaction. The two-staged one included: (Stage 1) shock and initial adaptation and (Stage 2) re-adaptation & spiritual satisfaction. However, the fulfilled spiritual needs may become unfulfilled again due to patient wavering life belief and physical distress.
The unfulfillment of the advanced lung cancer patients’ spiritual needs was involved with three developmental stages: (Stage 1) shock and initial adaptation, (Stage 2) spiritual distress, and (Stage 3) re-adaptation & spiritual disturbance. Some other factors of the unfulfillment of spiritual needs related to patients or their family members contained (a) family fear of patients unable facing death, (b) family unwillingness to accept the truth or doctor’s diagnosis, (c) family restriction on visiting for protective isolation, (d) family unwillingness to accept the truth or doctor’s diagnosis, (e) patient’s unwillingness to talk, (f) patient’s verbal impairment due to medical treatment or the handicapped, or (g) patient’s atheism or patients losing faith on God. Furthermore, some other factors which unfulfilled the patients’ spiritual needs were related to the medical professionals. They were: (a) worry about intruding patient privacy, (b) worry about the religious conflict with patients, (c) lack of spiritual care knowledge, (d) lack of time or (e) inadequate self-preparation.
The findings of this study can help health care professionals (a) to detect the patients with spiritual distress as early as possible, (b) to accurately or precisely assess their spiritual distress and needs, and (c) to provide the patients and their family members with holistic nursing practice by actively unifying the help or support from the patients’ relatives and friends, the health care professionals, and religion or/and religious groups. Furthermore, they can help schools emphasize life and death, spiritual nursing, and palliative nursing education, which in turn facilitates health care professionals’ understanding the knowledge and skills in spiritual nursing. In addition, these findings could be a tool for quantitative questionnaire development and be a guide to the spiritual care model for domestic cancer patients.

並列關鍵字

qualitative research ； advanced lung cancer ； spiritual distress ； spiritual needs ； spiritual well-being

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