癌症專科醫師慰語溝通行為之研究

Abstract

本研究之目的在於探究癌症病房醫師慰語溝通行為之內涵，包括語文安慰策略與非語文安慰行為。癌症目前為國人身心健康的威脅之一，病人在初期診斷患有癌症之後，接踵而來的病情變化及治療過程，常使癌症病人出現身體病痛及情感苦惱症狀。過去的研究固然結果顯示來自家人與醫護人員的情感支持有助於癌症病人的病情調適，但並未特別探究病人情感苦惱部分，而社會支持方面的文獻也很少將醫師視為病人的支持來源以進行評估。所以本研究從醫病溝通的角度，以六名癌症專科醫師為研究對象，透過醫師和病人於門診及病房的互動情境，探究醫師慰語溝通行為之內涵，其中包括語文安慰策略及非語文安慰行為。文中將探究慰語溝通的定義與重要性，並分別根據源自結構學派的複雜慰語策略之概念結構及非語文溝通系統，發展一套用來觀察癌症專科醫師的語文安慰策略及非語文安慰行為的量表，並透過參與觀察法及內容分析法探究六位癌症專科醫師慰語溝通策略及行為。研究結果發現六位醫師經常運用的慰語策略集中於「認同」、「說理」、「認同與說理」策略，極少運用「責備」及「展望」策略安慰病人。此外，本研究於九種慰語策略外，另發現其他隱含安慰特質的策略：闡釋、承諾、鼓勵、指引及閒聊或說笑五種策略。在非語文安慰行為方面，六位醫師常運用微笑、點頭、手勢及碰觸等方式表達對病人病痛的瞭解及支持。

The aim of the research is to examine the cancer physicians’ comforting communication, including verbal comforting strategies and nonverbal comforting behaviors. After patients are diagnosed of cancer and the therapy followed, they often suffer from enormous pain, various kinds of discomfort, and especially, emotional depression. The past researches had confirmed that the emotional support from the family, physicians and nurses could help patients adjust to new care and conditions, the present research studies how cancer physicians comfort their patients. Based on the concept of the structuralism’s sophisticated comforting strategy and nonverbal communication system, the present researcher develops an observation form to record the cancer physicians’ verbal comforting strategies and nonverbal comforting behaviors. This research uses the methods of purposive sampling, participant observation and content analysis to study the six physicians’ comforting communication to patients in health care settings. Results indicated that these physicians often acknowledge patients and help them to seek advice, treatment, and endure. And they express some nonverbal messages such as eye contact, smile and pats to comfort patients.