| Summary: | 碩士 === 國立陽明大學 === 臨床暨社區護理研究所 === 96 === Aims. The aims of this project tried go to explore the anticipatory grieving process (AGP) experienced by Taiwan’s terminal cancer patients’ families (TCPF), the influencing factors, and their needed help as well as suggestions for the health professionals (HP).
Methods. A prospective and explorative qualitative research design was employed. A purposive sample of 16 informants (including 8 males and 8 females) obtained from a hospice home care center of a leading teaching hospital with reputations of hospice care for oncology patients in the northern Taiwan.
Results. Fifty-six percent of the informants (n = 9) were the dying patients’ spouse. The age of the informants ranged from 50 to 69 years old (mean = 58). Forty-four percent of the informants (n = 7) received senior high school education; 37.5 % of the informants (n = 6) were Confucianism believers.
The AGP reported by the informants is a complex dynamic phenomenon encompassing a series of continuous stages of grieving for loss, initial reflection, practicing coping strategies, and second reflection & outcomes. A grieving cascade and physical discomforts were involved in the stage of grieving for loss. The reflections on the relationships between the dying patients and the informants as well as the informants’ conceptions and attitudes of health were involved in the stage of initial reflection. The following six coping strategies were practiced in this stage: (a) providing timely and needed help for the patients; (b) gradually realizing and preparing for the approaching death of the patients; (c) practicing self-adjustment; (d) searching for supportive avenues to release stress; (e) preparing for the tangible issues related to death and after-death; and (f) offering possible accompany with the dying patients. Three major efforts were found in the final stage of second reflection & outcome: (a) learning the meanings of life; (b) readjusting the relationships of family members; and (c) modifying social interactions.
The influencing factors of AGP include dimensions of the informants per se, the dying patients, other families and relatives, and environment. The major tangible difficulties encountered by the informants were: (a) the break down of personal original role's functions; (b) intense stress related to the overload of taking care of dying patients; (c) various detailed difficulties involved in the caring-delivery process; (d) over-long process of hireling a paid aid from other countries; and (e) heavy economic burden for caring the dying patients.
The informants’ needs were identified as offering patients with good quality medical treatment and nursing care, supporting systems for the primary caregivers, and humanistic environment for patient’s peaceful death in the hospital.
Conclusions. Finally, some conceptual frameworks were further developed to depict this complex phenomenon. Meanwhile, several directions were also suggested for future researchers in: (a) Is there difference in gender issue while family members tried to help patients develop living wills in patient’s dying process? And what difficulties as well as needed help for male and female care-givers? (b) How do the efforts in the stage of 2nd reflection influence male and female care-giver’s grieving process after patient’s death? (c) What are the primary care-giver’s caring experiences for the dying patients while approaching the last phase and moment of death from different religious affiliations’ perspectives? And (d) Is there any difference between male and female care-givers’ grieving process in losing their children or non-children?
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