從加護病房家屬觀點探究重症病情告知的經驗

Experience of Truth-Telling From the Viewpoints of Family in the Intensive Care Units

背景：病情告知是減少醫病認知落差的重要步驟，且能減輕家屬心理壓力。現階段研究仍缺乏家屬對重症病情告知經驗及需求之探討。目的：瞭解重症家屬病情告知經驗及過程需求。方法：採描述現象學，立意取樣5位加護病房疾病嚴重度≥20分的病人家屬進行深度訪談。以Giorgi現象學分析法，利用Nvivo 11分析歸納資料。結果：整體經驗包含四大主題：（一）訊息聽了無法懂，希望疑問詳細解、（二）無助找尋為解答，期望護理來幫忙、（三）託付專業卻無奈，渴望醫療多些愛、（四）重重難關多牽絆，盼望見解來割斷。結論／實務應用：病情告知著重傳遞結果，家屬無法理解病情變化原因。本研究建議醫療專業人員應體認家屬認知程度，並顧及其情緒反應，納入家屬需求及期待，以病人為中心提供個別化告知。

Background: Truth-telling is an important step toward reducing the cognitive gap between physicians and patients as well as reducing the psychological pressures applied to physicians by family members. There is a lack of research on the truth-telling experience and needs in the intensive care unit from the perspective of patient family members. Purpose: This study is designed to explore the experiences and needs of families in the intensive care unit. Methods: A descriptive phenomenology method was used in this study. In-depth interviews were conducted with five participants who had family members assessed with acute physiology and chronic health evaluation II scores ≥ 20. Data were analyzed using Giorgi's phenomenological methods and Nvivo 11. Results: Four experience themes were examined, including (1) nothing is clear, requires explanation| (2) helpless to find answers, need a nurse to resolve this issue| (3) professional conduct makes us feel helpless, longing for love from the medical team| (4) decisions are very difficult, hoping to get more help. Conclusions/Implications for Practice: The family members expressed that they were unable to understand the underlying causes of the progression in patient condition because the medical team only presented outcomes to the family and did not discuss related causes. Thus, it is recommended that medical teams learn to recognize the cognitive processes of patient family members and consider their emotions, including their needs and expectations, in order to provide individualized explanations based on a patient's status and progress.