2017-08-012024-05-18https://scholars.lib.ntu.edu.tw/handle/123456789/714408摘要：陪伴癌末患者邁向臨終過程到過世後的心理軌跡與悲悼歷程，需以長期追蹤觀點探究，方能從置身脈絡考察處境現象。目前緩和醫療的全人照護對象，多關注臨終病人本身，對其家屬長期心理陪伴後，悲悼療癒模式的在地化建構，較為不足。本研究透過文獻考掘、國外量化評估工具的修訂與本土質性資料的沈浸分析，從西方悲傷治療理論轉向華人文化的悲悼療癒觀點，嘗試建構臨終照護現場的心理陪伴經驗軌跡和悲悼歷程，以期瞭解與協助癌末患者家屬。 預備研究中，深度分析縱貫式癌症逝世患者家屬的質性訪談資料，發現「象徵持續性聯結的運作」在本土悲悼歷程轉化的重要性。因此，規劃「三年一期」的研究，嘗試釐清現象本身。 第一年的「奠基」研究，著重在基本測量工具的翻譯、修訂和編製，特別重視文化脈絡下的持續性聯結意涵，以及悲悼語詞的本土化意義，並探討心理評估工具的信度與效度。 第二年的「實徵」研究，以質、量化典範並進的混合設計研究，一方面將測量工具施測悲悼家屬，於緩和醫療病人逝世前，過世後三個月、六個月、一年和一年半，五個時間點的追蹤測量，觀察悲悼心理經驗的轉化。另一方面，從中深度訪談20名參與研究者，以蒐集經驗資料，探索受苦互動過程所遭逢見證的轉化。 第三年的「應用」研究，則統合第一年和第二年的研究結果，嘗試將研究發現與臨床應用結合，以深度訪談資料搭配心理評估工具統計，經由量化指標和質性典範雙重徑路，並透過醫療團隊至少2到3次的密集訪視，協助、促發悲悼家屬的象徵關係轉化，嘗試建立華人關係倫理取向的「後臨終心理陪伴與悲悼歷程療癒模式」，並反思其實踐效果。 綜合「三年一期」計畫的追蹤，預計透過多元研究典範的比較對話，最後重新「再脈絡化」文化社會處境，以時間性視域思索悲悼現象與存有意義，從生命義理角度，提出本土化心理陪伴模式或悲悼療癒概念理論，進而轉化臨床應用。 <br> Abstract: Caring patients with terminal illness as cancer is a stressful experience. In the field of palliative care, caregivers of cancer patients often express a certain degree of distress and psychological painfulness. Some of the caregivers might need professional help to go through it. However, there is no specific program of anticipatory grief intervention for Taiwanese caregivers. The aim of the present study is trying to construct a palliative care program and understand the ‘bei dao’ healing trajectory for Taiwanese caregivers of terminal illness patients. In pilot study, we analyzed qualitative interview data of bereaved caregivers in depth. We found that continuing bonds which were working in symbolic horizon played an important role in caregivers’ mourning process. In the first year basic study, we’ll translate Hogan Grief Reaction Checklist (HGRC) and continuing bond scale into Chinese version, and add the “symbolic continuing bonds” as a cultural specific dimension in continuing bond scale. In the second year empirical study, we’ll conduct a quantitative-qualitative longitudinal mixed design study to measure both quantitative change and qualitative transformation of ‘bei dao’ process in Taiwanese caregivers. In the third year application study, we’ll try to construct a psychological compassion and healing processes model based on the results of previous two years studies, and we’ll disclose the change effect of caregivers’ mourning reaction and transformation of continuing bonds before and after the psychological contact support. To summarize, the outcomes of the longitudinal study would be driven and analyzed from the clinical immersement and phenomenology psychology research. After the longitudinal study, we hope we can make the contribution to the clinical health psychology from the local context compared with the western model about the mourning stage model. From the long-term built data as the foundation, we will plan the development of the indigenous clinical psychology will be realized after the compressive research.關係再聯結悲悼心理軌跡心理療癒現象學心理學psychiatric patientphysical disabilitytraumasufferingtransforming