與癌童談論死亡的策略

Strategies for Discussing Death with Child Cancer Sufferers

近年來由於生死學課程的開設以及安寧療護的推動，逐漸的意識到了臨終病人的需要，然而由於東方文化的特殊性，家屬之決定權往往凌駕於病人之上，以致於臨終病人常未被告知疾病現況，更遑論是心智年齡未臻成熟的兒童。本文旨在藉由文獻查證的過程，了解與癌童談論死亡的必要性以及溝通策略，文獻整合結果發現，協助父母與癌童談論死亡、以及適當的讓兒童參與治療的相關決策，可以幫助父母度過孩子死亡後的哀傷期。護理人員在與兒童談論死亡時可以使用的溝通策略包括：確認家庭中的決策者、配合病童的年齡階段及對死亡概念的發展、討論疾病進展的軌跡、及選擇溝通的媒介。期望藉由此文獻查證，使國人重視此議題，並作為護理人員照護此類病患的參考。

Since a curriculum concerning life and death was established and palliative care began to be promoted, people have gradually awakened to the needs of dying patients. Because of the nature of oriental culture, however, ultimate decisions concerning someone with a terminal disease have traditionally been made by family, so dying patients, especially children with cancer, have usually not been told of their true condition. The purpose of this article was to gain an understanding of the necessity of talking about death with child cancer patients and how to communicate with these children. The results show that helping the family to talk about death and decision making concerning treatment can help them to adapt to the grieving period when the children pass away. The tactics that nurses can use for communication with dying children include: to acknowledge the decision maker in the family, adopt the concept of death appropriate to a person of the child's age, discuss the prognosis for the development of the disease, and opt to use the medium of communication. The findings of this article may serve as a source of reference for nurses caring for dying children, and cause greater attention to be paid to these issues.