從醫護人員角度探討癌末病人之靈性需求

Spiritural Needs of Terminal Cancer Patients from the viewpoint of Medical Professionals

提供癌末病人及家屬身心靈整體性的照顧，為每一位醫療人員應有的道德責任。本研究為探討國人於癌症末期時之靈性需求，採立意取樣選取某醫學中心21位癌症末期成年患者，由其主護護士依靈性評估指引及結構式問卷，以訪談方式進行資料收集。研究結果發現57.1%的癌末病人不知道、不瞭解或不會描述何謂靈性。訪談前，病人自覺有靈性需求者僅佔9.5%，但依靈性評估指引訪談後，病人表示有靈性需求者占61.9%。此外，訪談前，主護護士評估病人有「靈性需求」及察覺病人內心深藏的「負向心理情緒狀態」分占66.6%及42.9%，而主護護士依評估指引訪談後，上述兩者，都增加到76.2%。訪談結果，癌末病人目前靈性需求之內涵，包括：(1)71.4%的癌末病人，覺得宗教信仰對其人生很重要且有影響，病人因癌末住院，而改變其執行宗教儀式或活動者，占47.6%。(2)配偶、子女及父母親是病人最重要且具影響力者。(3)癌末病人的希望與力量，主要源自家人(33.3%)及信仰(23.8%)。(4)近一半(47.6%)的癌末病人，會改變其生活型態，並重新詮釋生命的意義與價值，其中23.8%的病人，由「為家人或自己，積極求取名利、賺錢以及生命較為重要」轉變成「樂觀平靜、順其自然以及祈求家人健康與尋求生命之意義感」，其餘(23.8%)則轉變成「對生命毫無寄託，沒有希望與未來」等消極與負向的想法。本研究結果顯示：國人於癌末時，對靈性之需求常潛藏於內心，醫護人員不易察覺，制定「靈性評估指引」應有助於提醒醫護人員，有機會深入評估癌末病人的靈性需求及提供適切性照顧，促進安寧療護全人照顧之目標。

Providing total care for terminal cancer patients is the moral responsibility of medical professionals. This study was done to investigate the spiritual needs and clinical manifestations of terminal cancer patients. Twenty one terminal cancer patients were intensively interviewed with an interview guide by their primary care nurses. The results showed that 57.1 % of interviewed patients couldn't describe what spirituality is. Otherwise, the spiritual needs of patients were arisen apparently after interview (from 9.5% to 61.9%). Meanwhile, 'the spiritual needs' and 'negative emotional status' assessed by nurses also increased from 66.6% and 42.9% to 76.2% and 76.2% before and after interview. The results of interview showed that (1) Nearly half of patients (47.6%) have changed their religious activities, (2) The most significant others were spouse and children, (3) Hope and power originated from families(33.3%) and religion(23.8%), (4) Of those interviewed, 47.6% had modified their meaning and value of life; unfortunately, in half of respondents, it : hanged to negative preception (23.8%). The study showed that terminal cancer patients have potential spiritual needs and a tool for assessment of spiritual needs would help medical professionals to perceive spiritual needs and properly provide spiritual support for dying patients.