癌末病患與其主要照顧者之意義調適歷程與內涵初探

Abstract

本研究目的是探討癌末病人（及其主要照顧者）在獲知自己（家人）的疾病進入末期時，其情境意義與整體意義的調適與轉化情況，以及其最後達成之意義內涵。依據Park與Folkman（1997）的意義因應理念架構，以半結構焦點訪談法，訪談9位癌末病人，10位主要照顧者。依病程區分為初始獲知、治療休養、復發轉移、進入末期四個階段，分別探討病人（和其主要照顧者）於每個階段的情境意義與整體意義之調適與轉化及最後形成的內涵。研究結果發現，情境意義在病情發展的不同階段，對於死亡逼近的威脅性有所不同。整體信念意義與目標意義在不同階段的調適亦各具重要性。整體信念意義的調適在初始獲知的強烈衝擊下扮演重要角色，衝擊趨於平衡後有助於進入末期時的死亡接受度；整體目標意義於病程進入末期時在意義的尋求與創造歷程中極為關鍵，病人與主要照顧者最常見的共同的替代目標為珍惜當下，做最後的深度情感交流。此外，結果顯示病人在進入末期時對死亡的接受度比照顧者高。另方面也發現，雙方在接受度上有互相影響的現象。

This study aimed to investigate the meaning-making processes and its contents in terminal cancer patients and their chief caregivers. Based on the integrated meaning-making coping model proposed by Park and Folkman(1997), nine terminal cancer patients and ten chief caregivers were interviewed by a semi-structured focus interview method in present study. Four stages of disease were distinguished for data analysis: the-first-time-diagnosed-with-cancer stage, treatment-and-rest stage, relapse-and-metastasis stage, and terminal stage. Results revealed that the transformation of situational meaning differed in different diseases stages, and the making of global-beliefs meaning and global-goals meaning played different roles in different disease stages. Remaking global-beliefs helped moderate the impact of initial diagnosis and the acceptance of stepping into terminal stage. Remaking global-goals constituted the central parts of meaning-making processes in the terminal stage. “ Appreciation the caring concern of each other in every moment ” was the most achieved remaking goal in patients and their chief caregivers. Besides, patients showed higher level of acceptance of death than chief caregivers as they stepped into terminal stages. However, there are interaction of the acceptance of death between patients and caregivers.