本篇報告分享照護一位罹患擴散期小細胞肺癌併發胸壁及主動脈轉移男性病人之過程，照護期間為2011年9月26日至2011年12月2日，過程中病人因胸壁腫瘤快速生長，病情快速變化，治療計畫由積極之外科手術轉變為末期安寧療護。藉由傾聽、會談與身體評估等技巧收集資料建立信任感，分別對生理、心理、社會及靈性四個層面作整體性的評估，發現病人有：「癌症末期惡性傷口」、「與醫療團隊之目標衝突：堅持自主的醫療方式」及「癌末病情認知」等護理問題。筆者以一位專科護理師之角色，協助個案及女性友人面對預期性哀傷，促使個案及友人正向看待及接受即將來臨的死亡。過程中，強調專科護理師利用照顧者、教育者、諮商者、研究者及協調者等多重角色，整合各專科的團隊資源，協助病人及其親密友人無憾完成生命最後階段。

This case report shares the experience of taking care of a 52 year-old male diagnosed with small cell lung cancer and metastasis of chest wall and aorta in a surgical ward from September 26, 2011 to December 12, 2011. Due to the rapid growth of the chest wall tumor and quick progression of the disease, the treatment course was changed from aggressive surgical intervention to palliative and hospice care. Data were collected through active listening, interview and physical examination. Results of the physiological, psychological, social and spiritual assessment showed that the patient had problems on “malignant wound of terminal cancer”, “conflict with the medical team in therapeutic goals due to patient’s insisting on self-directed care”, and “knowledge of terminal cancer”. Being a nurse practitioner, the author helped the patient and his female partner faced the anticipated grief associated with terminal cancer, and established a more positive attitude toward death. During the care process, the roles of a nurse practitioner in direct care giver, educator, consultant, researcher and coordinator were emphasized and various resources from the multidisciplinary medical team were integrated to help the patient and his close relatives completing the final stage of the patient’s life without regret.