已故癌症病人之主要照顧家屬如何面對死亡？

How to Face Death for the Significant Caregivers of Dead Ill Cancer Patients?

張淑琦(Shu-Chi Chang) ； 林淑鈴(Shu-Ling Lin)

《安寧療護雜誌》 7卷2期 (2002/05) Pp. 109-127

https://doi.org/10.6537/TJHPC.2002.7(2).2

摘要

透過深度訪談法，本研究訪問高雄地區X醫院某癌症病房及Y醫院安寧病房十位已故癌症病人的主要照顧家屬，目的在於瞭解主要照顧家屬如何面對死亡？研究重點包括已故癌症病人之主要照顧家屬的身心狀況、求助行為與其評估，病人與主要照顧家屬之社會關係，比較已故癌症病人的主要照顧家屬如何面對死亡？
研究發現主要照顧家屬與病人依夫妻、婆媳、翁媳、祖孫、親子以及擬血親等六種關係延伸出不同的照顧責任，照顧者擔負照顧重任之原因有理所當然、沒有辦法、無可奈何以及心有餘而力不足等。讓主要照顧家屬堅守崗位的原動力是病人對照顧者直接傾訴或以只能意會不能言傳表達感激之情。照顧病人期間主要照顧家屬多遭遇經濟、情緒、身體等問題，在病人患病期間照顧者與病人曾求助於西醫療法、安寧療護、另類療法、社會福利資源等。
主要照顧家屬咸少在病人面前直接觸及死亡話題，當病人談及死亡時，主要照顧家屬多採取傾聽、安慰或避而不談的方式因應。偶有病人及家屬間接以交代後事、自殺、討論病情、表達感激等方式觸及死亡。主要照顧家屬面對死亡的態度，包括互助互惠、把握當下、面對現實、怨天尤人、逃避現實等應對機制。主要照顧家屬在面對死亡時可能介於前述兩應對機制之間，或有兩種以上的應對機制。應對機制因人、因事、因情境而易，它不僅可以反應病人與主要照顧家屬的關係，病人與主要照顧家屬面臨的困境，甚而求助之道。是以可視面對死亡之應對機制為病人與主要照顧家屬互動關係之鏡像反應，它不只銜接過去，且在開啟未來。文末討論病人與主要照顧家屬成為醫療系統中的迷途羔羊，解脫之道－自殺或安寧療護？主要照顧家屬對醫護人員的評價不同，以及死亡與再生等課題。

並列摘要

A Family is always responsible to the ill cancer patients for health promoting and care giving in Taiwan. It influences the significant caregiver's bio-psycho-social condition for a family with ill cancer patients especially. This research through in-depth interview studies ten cases from a hospital's surgical ward of oncology and a hospice care center of the other one in Kaohsiung City. After looking for the history of ill cancer patients getting illness and asking for help, the research aims to answer the following questions. (1)What's the social relationship between dead ill cancer patients and their significant caregivers? (2) What's the bio-psycho condition of the dead patients' significant caregivers? (3) How to ask for help and evaluate the health-promoting center for the dead patients' significant caregivers? (4) How to face death for the dead patients' significant caregivers? The major findings represent that the dead ill cancer patients' significant caregivers have over bio-psycho-social burden continually, they usually search for multiple healing, make different evaluation and have five types of coping mechanism to face death. Some patients' significant caregivers have only one but the others have two or three types in the meantime though there are five ones. Five types of coping mechanism are as follows. (1) Reciprocating: That the best you do, the most rewards you get. (2) Living well: Where there is a will, there is a way. (3) Accepting: Naturally everybody will die. (4). Denying: Neither talking about the dead truth, nor accepting it. (5) Retreating: Being depressed and withdrawn from the goals and means of a society.

並列關鍵字

significant caregivers ； dead ill cancer patients