面對一位未被告知罹患膀胱癌末期病人之照護經驗

A Patient with Terminal Bladder Cancer Who was not Informed of the Disease

本文為面對一位未被告知罹患膀胱癌末期病人之照護經驗，照護期間自2020年12月26日至2021年1月19日，以病人為中心，運用生理、心理、社會及靈性四大層面進行整體性護理評估，透過傾聽、觀察、身體評估、會談及病歷蒐集主、客觀資料，護理過程以Swanson關懷理論，依據疼痛控制原則及舒適護理緩解疼痛不適，家屬以擔心告知罹癌末期會使個案喪失求生意志為由，請求醫療團隊對個案隱瞞部分病情，但善意的謊言可能會造成個案遺憾，為筆者選案理由，後鼓勵家屬如實告知個案病況，讓個案掌握自主權，藉由家庭會議使用病情告知六步驟「SPIKES」，讓個案掌握病情真相，透過跨團隊合作模式，幫助個案找尋生命中的意義，使其獲得生理、心理及靈性平安，提升末期生活品質，以增進個案身體舒適，運用善終照護理念使個案有尊嚴地走完人生最後一哩路，並陪伴及引導家屬以正向態度安然面對個案死亡的哀傷情緒，期盼能生死兩相安。建議醫護同仁重視癌末病人病情告知重要性及原則與策略，使病人在末期仍能保有生命的自主與尊嚴。期望藉此全人照護之經驗可供日後臨床照顧癌末病人之參考。

This article is about the care experience of a patient who was not informed of her terminal bladder cancer. During the period of care from December 26, 2020 to January 19, 2021, a holistic patient-centered nursing assessment was conducted using the four major dimensions of physiological, psychological, social, and spiritual care, and the patient's subjective and objective information was collected through listening, observation, physical assessment, interview, and medical records. The nursing process was based on Swanson's theory of caring, and pain control and palliative care were used to alleviate pain and discomfort. The family members requested the medical team to conceal part of the medical condition of the case for fear that informing them of the terminal stage of the cancer would cause them to lose the will to live, but a wellintentioned lie might cause regrets, which was the reason for the author's selection of the case. SPIKES'' through the family meeting to let the case know the truth of the disease, through the cross-team cooperation mode, to help the case find the meaning of life, so that the case can obtain physical, psychological and spiritual peace, to enhance the quality of life at the end stage, to increase the physical comfort of the case, to utilize the concept of hospice care so that the case can finish the last mile of life with dignity, and to accompany and guide the family to face the grief of the case's death with a positive attitude in the hope of We hope that they can live and die in peace with each other. It is recommended that healthcare professionals emphasize the importance of informing terminal cancer patients of their condition, as well as the principles and strategies to enable them to maintain their autonomy and dignity in life at the end stage, and we hope to share this experience with our colleagues for future reference in clinical care.