| Abstract: | 骨髓移植病患生命拼鬥歷程研究本研究針對罹患血癌且接受骨髓移植患者，就他們的治療與生命轉變歷程進行探究。分析病患看待自己罹患重症的成因，詮釋他們克服生命危機的關鍵要素。研究目的為：第一、剖析接受骨髓移植病患面對疾病的生死態度。第二、探索出骨髓移植病患克服生命困境的因應模式。第三、形塑腫瘤社會工作介入癌症病患服務的觀點與內涵。本研究以質性研究的深度訪談為方法，根據立意抽樣訪談18位個案，訪談對象共有7位接受親屬移植、6位接受異體非親屬移植、5為接受自體移植。資料分析訪法以生命史（life stories）做為基礎，在理論運用上則採納存在主義(existentialism)、關懷倫理(ethics of care)與生死學(life-and –death studies)等觀點。本研究從受訪者的就醫經驗、生命困境、因應策略、生死態度與拼鬥觀點呈現分析。（一）就醫經驗顯示，病患在隔離期間，容易出現疼痛感、孤獨感、浮現死亡意念，而震驚、哀傷、慌亂等為典型情緒反應。（二）病患面臨的生命困境包括：因病而生的愧疚感、復發的挫折感、身體心像改變的衝擊、照顧型態的干擾等。（三）因應策略綜理為：補償性策略、反依賴策略、防衛性策略、隱瞞性策略、寄託性策略與釋懷性策略。（四）病患其生死態度，會受到鉅視面向的文化或信仰因素，以及個人生活經驗的主觀因素融合影響。（五）本研究所提出的拼鬥觀點（fight perspective）意指，個人透過內省過程，產生掌握自己生命發展的力量，在自由意志抉擇下，訂定具希望感的行動目標，並適切運用外在支持系統，讓自己生命品質達到最佳狀態。研究者從「支持系統能力」與「病患拼鬥意願」二個向度，提出「骨髓移植病患生命因應模式」，共區分為：停滯模式、推促模式、獨立因應模式與共同拼鬥模式。研究結果顯示，從病患的生命發展歷程，可以發現到，為追求生命存續，當事者必須做出許多決定和行動。第一是心念轉變；第二是行動改變。對於病患生命拼鬥歷程的內涵，研究者從「對生命存在的態度取向」與「面對疾病的認知與行動」二的向度，提出骨髓移植病患面對疾病的拼鬥類型，並形成四種拼鬥類型：停滯式拼鬥、順應式拼鬥、擺盪式拼鬥與積極式拼鬥。本研究並針對提供癌症病患服務的腫瘤社會工作者，結合拼鬥觀點，提出展現專業服務的六項內涵，分別為：臨床運用原則、處遇介入面向、服務方式、服務內容、社工人員角色與實務技巧。最後，本研究對於社工實務應用與建議有下列四點：第一、建立以關懷為基礎的服務策略；第二、協助案主轉化挫折經驗；第三、以拼鬥力激發案主內在能力；第四、促進跨專業協同合作服務。
The study of life fighting process for bone marrow transplantation cancer patientsThe purpose of this study was to explore the attitude and the coping mechanisms of patients with leukemia who have undergone bone marrow transplantation. The specific objectives of the study were as follows:1. To analyze the bone barrow recipients’ attitude towards life-and-death.2. To explore the coping mechanism for life crisis and distress.3. To further defined the role of social work in the care of oncology patients. This qualitative research was based on in-depth which included 18 interviewees enrolled by convenience sampling. Seven of the 18 interviewees were recipients of living-related donors, 6 interviewees were recipients of living non-related donors, and the remaining 5 interviewees were recipients of autologous bone marrow transplantation. The method of research was based on life stories, analyzed from the perspectives of existentialism, ethics of care, and life-and-death studies.The major findings of this study were as follows:1. Clinical evidence showed that patients often experienced pain, loneliness, shock, sorrow, panic, and had thoughts of death during the isolation period.2. The difficulties that patients faced included guilt arising from the illness, frustration with disease recurrence, shock from body image transformation, and the conflicting opinions regarding the most optimal method of care. 3. The patients’ coping strategies included compensatory strategy, anti-dependence strategy, defensive strategy, concealment strategy, entrust strategy, and relieved strategy.4. The patients’ attitudes towards death were affected by cultures, religions, and their own subjective life experiences.5. The so-called fight perspective in this study is a process of managing life development, through introspection, by setting optimistic goals and using the support resources to improve the quality of life.Based on the Resource Management and the Will to Fight dimensions, the investigator proposed the following coping models of bone marrow transplantation cancer patients: stagnation model, push-pull model, independent coping model, and collaboration fighting model.The result of study indicated that patients had to make many decisions and take a action in order to keep life lasting. The investigator used two dimensions, Attitude toward Life Meaning and Cognition & Action about Disease, to created the stop fighting model, adaption fighting model, hesitation fighting model, and active fighting model.This study provided a professional service model for social workers involved in the care of oncology patients. With the fight perspective, there were six subject matters in the service model: the clinical practice standards, the elements of intervention, the method of service, the content of services, the role and the working skills of the social workers. Based on the results of this study, the investigator developed the following suggestions: 1. To create a compassionate care service strategy;2. To assist the patients overcome the frustration;3. To empower the patients with the fight perspective;4. To promote multi-disciplinary professional network. |
