| Abstract: | 中文摘要當實際遇上自己的親屬生命末期之際，才會發現要面對生命末期醫療決策並非想像中那樣地簡單與容易。因此，本研究的目的在瞭解急重症專科醫師面對親屬生命末期醫療決策的生命經驗及感受，並探討醫師身為專家與家屬角色時的角色掙扎歷程。本研究採質性研究作為研究設計，以急重症專科醫師為研究對象，透過敘事研究分析的方法，於通過IRB審查後，面對面深度訪談六位於2000年之後曾面臨親屬生命末期醫療決策經驗、且現仍在執業中的急重症專科醫師。由研究對象敘說自己的生命故事經驗，再進行文本整理與分析。研究發現急重症專科醫師在生命末期醫療決策時的認知改變模式，以及生命末期議題應用到雙重家庭壓力理論時的理論修正。研究結論整理出急重症專科醫師面對親屬生命末期醫療決策時，在認知、現實、執行層面與角色行為上的意義與特徵，包括：一、在認知層面上，醫師所處的人生發展階段、執業場域、習醫行醫經驗及面對生命的態度有其重要意義。二、在現實層面上，醫師會成為家庭核心的重要角色，以及發現陪伴的重要性。三、在執行層面上，醫療決策會受到醫療處置侵入性及溝通討論的程度影響。四、在角色行為上，會受到家人對其社會角色行為的期待及現實考量下的情感抽離影響。最後，根據研究發現與結論，提出對醫療從業人員、醫學教育、生命末期議題應用雙重家庭理論、醫務社會工作領域發展、生命末期政策以及未來研究的建議。藉此用以提供醫務社會工作者瞭解服務對象及醫療團隊在面臨醫療決策時的難處及提供專業處遇。關鍵字：急重症專科醫師、生命末期、醫療決策、專業角色、家庭角色
AbstractIt is difficulty to do the medical decision-making of end-of-life about their family members, even for physicians. The objective of this research was to explore the struggles between the professional and domestic role for the emergency and critical care physicians.The study was designed as qualitative research using in-depth interviews for the emergency and critical care physicians. Six physicians who were ever faced with the medical decision-making of end-of-life about their family members after 2000 were recruited. The narrative analysis was used to comprehend their experiences.The research disclosed the participants’ cognition change model for the end-of-life decision-making, and modified the double ABCX model when the end-of-life issue among physicians' families applied it. The results showed the physician’s stage of development, working place, experiences of learning and being a doctor, and the attitude toward to life were all crucial in the cognitional level. In the reality level, the physicians were the key person in their families and found the necessary of the companion. In the clinical level, the invasive treatment and communication among their family’s members wound affect the medical decision-making. In the level of role behavior, the expectation and a feeling of detachment wound influence the physicians.The qualitative research revealed the struggles among these physicians. At last, the suggestions of the health care providers, the medical education, the double ABCX model applied to the end-of-life issue, the development of medical social work, the policy of end-of-life, and the further study could take this study as reference. For medical social workers, we can be aware of the struggles of the family and medical teams to help them.Key words: the emergency and critical care physicians, end-of-life, medical decision-making, professional role, domestic role |
