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研究生:郭淑芬
研究生(外文):Shu-Fen Kuo
論文名稱:從癌症病人及家屬觀點探討病情告知之經驗
論文名稱(外文):The Experience of Truth-Telling from Cancer Patients and Families’ Perspectives
指導教授:胡文郁胡文郁引用關係
指導教授(外文):Wen-Yu Hu
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:184
中文關鍵詞:經驗障礙因素病情告知癌末
外文關鍵詞:experiencetruth-tellingcancer terminal statuspuzzle
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本研究為問卷調查法,旨在探討癌症病人及家屬被告知癌症病情之實際經驗、理想方式以及其障礙因素。研究對象為住院的癌症病人及家屬,採立意取樣,於北市某醫學中心及腫瘤專科醫院,以結構性問卷面對面訪談方式進行資料收集,共收案53位病人,66位家屬,所得資料以SPSS11.0版之套裝軟體進行統計分析。主要研究結果為:1 )癌末病情告知比例比癌症診斷告知比例低。2)病人及家屬被告知癌症病情實際經驗主要由主治醫師告知(79.2%、63.6%),其中病人的癌末病情有40.0%是由家屬告知;病情告知的時機,大多數病人及家屬在有醫學檢查報告後被告知(73.6%、56.1%),而癌末病情在病情惡化時才告知病人的有33.3%,家屬則是26.3%,其他在告知者的語氣態度以及病情的內容上,癌症診斷與癌末病情的告知有顯著的差異。3)在病人被告知癌末病情實際經驗�堙A病情內容方面較少提及疾病的自然發展過程、持續積極治療的壞處以及治療或疾病對生活的影響,病情告知後主治醫師較少給予病人心理情緒反應的處理,護理人員在告知過程中較少扮演任何角色,而理想上病人的期待是相反的。4)家屬告知癌末病情最大障礙因素為病人的情緒穩定度(89.1%)。病人年紀越大,家屬告知癌末病情意願越低
(χ2=4.69,p<.05)。
由研究結果得知癌末病情的告知有較高的困難度,尤其家屬是一大阻礙因素,因此醫護人員對於癌末病情的告知,應協助家屬克服癌末病情告知困境以及減少病人實際經驗與理想的差異,以尊重病人自主權,進而提升末期醫療照護品質。
關鍵詞:癌末、病情告知、經驗、障礙因素
Abstract
The purpose of this study were to investigate the experience of truth-telling on cancer patients and families, and to explore an ideal way for executing truth-telling and its obstacles. Questionnaire survey was employed in this study. The subjects were 53 cancer inpatients and 66 family members conveniently recruited from a medical center and a cancer comprehensive center in Taipei. The data was collected by a structured questionnaire. The collected data were analyzed using SPSS11.0. The findings were as follows: 1) There is a lower percentage of health providers to tell terminal information than to disclose cancer diagnosis. 2) 79.2% of patients and 63.6% of families were informed the cancer information by physicians, and 40.0% of patients were informed by their family members directly. 73.6% of patients and 56.1% of families were informed after examination completed. 33.3% of patients and 26.3% of families were informed after aggravation of the patient’s condition. There was a significant difference between telling terminal information and cancer diagnosis on the attitude of the truth teller. 3) According to the patient’s experience on being told the truth, the natural development of the disease, the weakness of doing aggressive therapy continuously, and the impact of the disease on life were seldom discussed. After truth- telling, the physicians rarely took care of the patient’s psychological response. The nurses seldom played any role during truth-telling, which is not in accordance to patient’s expectation. 4) The greatest factor influenced family’s willingness to tell the truth is patient’s emotional steadiness(89.1%). The older the patient, the more unwillingness of his/her family to tell the truth (χ2=4.69, p<.05).
In conclusion, it was a difficult situation in informing terminal information, and the family member’s willingness was the greatest factor. As to truth-telling, physicians and nurses were should help the families to overcome the dilemma of truth-telling, and decrease the discrepancy between the patient’s expectation and real situation. This will help increase patients’ autonomy and thus promote the quality of terminal medicinal caring.
key words : cancer terminal status、truth-telling、experience、puzzle
目  錄
誌謝…………………………………………………………Ⅰ
中文摘要……………………………………………………Ⅱ
英文摘要……………………………………………………Ⅲ
目錄…………………………………………………………Ⅴ
圖表目錄……………………………………………………Ⅷ
第壹章 緒論
第一節 研究動機與重要性………………………………1
第二節 研究目的…………………………………………5
第三節 概念架構……………………………………………………………6
第四節 名詞定義…………………………………………9
第貳章 文獻查證
第一節 疾病末期與病情告知的定義……………………11
第二節 倫理基本原則及告知權利和義務………………15
第三節 病情告知的模式…………………………………21
第四節 病情告知的原則及步驟…………………………23
第五節 影響病情告知的因素……………………………28
第六節 病情告知後的反應………………………………34
第七節 癌症病情告知的相關性研究……………………36
第參章 研究方法
第一節 研究設計…………………………………………44
第二節 研究對象及場所…………………………………45
第三節 研究工具………………………………………..47
第四節 研究步驟………………………………………..52
第五節 資料處理與分析…………………………………54
第六節 倫理考量…………………………………………56
第肆章 研究結果
第一節 病人及家屬基本資料……………………………57
一 基本屬性………..……..……………………………57
二 病情告知現況及意願…………………………………58
三 親友罹患癌症經驗及死亡態度……………………..59
第二節 病人及家屬被告知癌症病情之實際經驗與差異……………61
第三節 病人及家屬被告知癌末病情之理想方式與差異……………71
第四節 癌末病人被告知癌末病情實際經驗與理想方式之差異……78
第五節 家屬告知癌末病情障礙因素…………………………………79
第六節 家屬告知病人癌末病情意願之影響因素…………………..80
第伍章 討論
第一節 台灣文化脈絡下病情告知現況與意願………………………81
第二節 病人被告知癌末病情之理想方式-病人與家屬觀點之落差.87
第三節 老人病情告知之倫理相關議題.…………………………….93
第四節 護理人員於病情告知過程中之角色與功能…………………95
第五節 個案流失原因…………………………………………………96
第陸章 結論與建議
第一節 結論……………………………………………………………98
第二節 護理應用…………………………………………………...103
第三節 研究限制與建議…………………………………………….106

參考文獻…………………………………………………………….…109
中文部分………………………………………………………….109
英文部分………………………………………………………….113
附錄
附表一 末期定義……..………..………………………………….160
附表二 病人及家屬癌症病情告知與相關研究之比較…………….161
附表三 病人及家屬實際接觸一覽表………………………………162
附表四 病人及家屬拒絕受訪原因…………………………………162
附表五 病人及家屬中途停止受訪原因……………….………….163
附件一 研究工具同意書……………………………………………164
附件二 問卷內容效度專家名單……..……………………………165
附件三 病人病情告知之問卷..……………………………………166
附件四 家屬病情告知之問卷………………………...…….……171
附件五 家屬同意書…………..……………………………………180
附件六 病情告知問卷同意書(病人)……………………..……181
附件七 病情告知問卷同意書(家屬)………..…………………182
附件八 台灣大學醫學院附設醫院人體實驗同意書.………..….183
附件九 和信治癌中心醫院人體實驗同意書.……..………….…184


圖表目錄
圖 1 從癌症病人及家屬觀點探討病情告知之經驗之概念架構圖….8
表 1 病人與家屬之基本資料..…………………………………….121
表 2 病人被告知病情現況及意願………………………………….123
表 3 家屬告知病人病情現況及意願……………………………….124
表 4 病人與家屬之親友罹患癌症經驗及死亡態度……………….125
表 5 病人被告知癌症病情之實際經驗-從病人觀點….….………126
表 6 病人得知病情後的心理情緒反應及因應方式-從病人觀點…129
表 7 病人被告知癌症病情實際經驗中醫護人員及家屬之角色與功能
-從病人觀點……………………………………………………131
表 8 病人被告知病情後的滿意度.………………………………..132
表 9 病人被告知病情之實際經驗-從家屬觀點….……………….133
表10 病人得知病情後的心理情緒反應及因應方式-從家屬觀點..136
表11 病人被告知癌末病情之實際經驗-病人及家屬觀點之差異..138
表12 家屬被告知癌症病情之實際經驗….……………………....139
表13 家屬得知病情後的心理情緒反應及因應方式…………...…142
表14 家屬被告知病情實際經驗中醫護人員之角色與功能……...144
表15 家屬被告知病情後的滿意度.……………………….….……145
表16 病人被告知癌末病情之理想方式與差異-
從病人及家屬觀點...................................146
表17 醫護人員處理病人心理情緒反應之理想方式
-從病人及家屬觀點…..............................…149
表18 病人被告知癌末病情理想方式中醫護人員及家人之角色與功能
-從病人及家屬觀點……………………………………………150
表19 家屬被告知癌末病情之理想方式………………………….…151
表20 醫護人員處理家屬心理情緒反應之理想方式……..……….154
表21 家屬被告知癌末病情理想方式中醫護人員之角色與功能….155
表22 癌末病人被告知癌末病情之實際經驗與理想方式之差異.…156
表23 家屬告知癌末病情之障礙因素………….……..……………157
表24 家屬遭遇告知障礙因素之處理方式……….….…………...158
表25 預測家屬告知癌末病情意願之重要因子…………………….159
參考文獻
中文部分
王興耀 (1994)。告知癌症真相的探討。行政院衛生署國家科學委員會研究計畫。(NSC83-0301-H037-003)。
尹裕君、林麗英、盧小鈺、鄒海月、王曼溪、許凰珠(2002)。護理倫理概論。台北:華杏。
伊瑪紐(Emanuel, Ezekiel)(1999)。臨終之醫療倫理(柳麗珍譯)。台北:五南。(原著出版年:1957年)
安寧緩和醫療條例全文 ( 2002修正)
汪素敏、顧乃平 (2000)。照顧瀕死病人的倫理考量。國防醫學,31(1),72-78•
邱泰源 (1995 a)。終末期照顧的醫病關係-倫理觀。醫學繼續教育,5(3),294-299。
邱泰源 (1995b)。談我國安寧及緩和醫療照護的重要課題-與日本的比較。護理新象,5(4),8-13。
邱泰源 (1998)。安寧療護相關規範之研究─以倫理為基礎,行政院衛生署科技研究發展成果報告。(DOH87-TD-1079)
李明濱、廖士程 (2001)。心理腫瘤學概說。國防醫學,5(4),407-414。
李惠玲、湯梅芬、黃香香 (1994)。癌症病人家屬在照顧病人住院期間的壓力與因應行為。國防醫學,19(5),485-489。
周希誠 (2003)。老年人末期疾病照護的倫理困境與對策。台灣老年醫學會,52,5-9。
林淑鈴 (2001)。文化論述、社會建構與終極關懷:末期癌症病人之研究。國立清華大學人類學研究所博士論文,未出版,新竹市。
林梅玉 (2001) 。腫瘤科醫師告知病情之經驗研究。國立陽明大學衛生福利研究所碩士論文,未出版,台北市。
林宜靜 (2002)。臨終病人面對死亡之心理調適歷程。國立彰化師範大學輔導與諮商所碩士論文,未出版,彰化市。
林惠貞 (2004)。「安寧緩和醫療條例」實施後臨床困境初探-醫師的角度。私立南華大學生死學研究所碩士論文,未出版,嘉義縣。
姜安波 (1993)。重症醫療倫理綜論,內科學誌,4(4),263-278。
胡文郁 (2004)。癌症末期真相告知指引之訂定:癌末病人、家屬、醫師及護理人員的態度和行為意向的觀點,行政院衛生署國民健康局委託研究計畫研究報告。(DOH92-HP-1508)
莊英瑜、方秋萍(1992)。護理倫理。台北:南山堂。
唐秀治 (2001)。台灣地區癌症病人被告知疾病訊息狀態之研究結果。癌症關懷,16,41-45。
高淑芬、酒小惠、趙明玲、洪麗玲、李惠蘭 (2001)。老人死亡態度之先驅性研究,長庚護理,8(3),43-51。
許禮安 (1998)。臨終關懷之我見,應用倫理研究通訊,8,8-12。
許禮安 (2002)。病情世界初探-由病情告知談起。安寧療護雜誌,7(3),239-250。
許惠珍 (1998)。癌症死亡家屬對現行癌末醫療需求及其安寧療護之認知與態度之探討-高雄市。私立高雄醫學院公共衛生所碩士論文,未出版,高雄市。
許町子、杜異珍 (1997) 癌症病患和家屬對安寧照顧需求之探討。榮總護理,14(1),
11-22。
黃和美 (1985)。癌症末期病人對死亡心理反應知探討。護理雜誌,32(4),57-69。
陳彰惠 (1982)。探討癌症患者之家屬對「告訴病人真相」的態度。護理雜誌,29(3),29-38。
陳敏竣、姜安波、周志銘 (1995)。晚期癌症病情的披露。內科學誌,6(2),140-147。
陳敏竣、姜安波、俞玉潔 (1995)。癌症病情披露之臨床個案探討。台灣醫界,39(3),45-49。
陳敏竣、姜安波、黃湘萍、蘇連瓔 (1997)。癌症末期病人照護的倫理議題。台灣醫界,40(10),10-14。
陳榮基 (1997)。不予及撤除治療的法律及倫理層面的探討。醫事法學,9(1),15-17。
陳淑芳 (1999)。愛她,就應該讓她知道-個案分享,談疾病告知的藝術-心理師觀點。癌症關懷,10,41。
游翁斌、周稚傑、陳永煌 (1999)。重大病情之披露。國防醫學,28(6),491-494。
楊克平、尹祚芊 (1999)。癌末病患健康相關生活品質內涵之研究。護理研究,7(2),129-143。
潘湘如、杜明勳 (1997)。癌病病情告知。基層醫學,15(7),145-148。
趙可式 (2000)。第八次南區安寧療護院際研討會-臨終病人的病情告知。安寧照顧會訊,39,27-31。
蔡甫昌 (2000)。生命倫理學四原則方法初探。於戴正德、李明濱著,醫學倫理導論(pp.47-56)。台北:教育部。
蔡哲雄 (2001)。癌症告知的藝術。天下:台北。
蔡秀芬 (2001)。癌症病患病情告知與否及健康控制信念與希望程度之相關性探討。私立台北醫學大學護理所碩士論文,未出版,台北市。
劉寶愛 (2001)。癌症兒童的母親告知病童病情之歷程研究。私立東海大學社工系碩士論文,未出版,台中市。
鄭凱芸 (1999)。愛她,就應該讓她知道-個案分享,談疾病告知的藝術-社工師觀點。癌症關懷,10,42。
盧美秀(1998)。護理倫理學。台北:華杏。
鍾昌宏 (1999)。安寧療護疾病告知。安寧照顧會訊,35,74-76。
嚴久元 (1996)。當代醫事倫理學。台北:橘井。

英文部分
Akabayashi, A., Kai, I., Takemura, H., & Okazaki, H. (1999). Truth telling in the case of a pessimistic diagnosis in Japan. Lancet, 354(9186),1263.
Brewin, T. B. (1991). Three ways of giving bad news. Lancet, 337(8751), 1207-1209.
Barnett, M. M. (2002). Effect of breaking bad news on patients’ perceptions of doctors. Journal of the Royal Society of Medicine, 95(7), 343-347.
Blanchard, C. G., Labrecque, M. S., Ruckdeschel, J. C, & Blanchard, E. B. (1988). information and decision-making preferences of hospitalized adulat cancer patients. Social Science Medicine, 27(11), 1139-1145.
Blinov, N. N., & Hanson, K. P. (1997). Characteristics of physician-cancer patient relationships in Russia. Annals of theNew York Academy of Sciences, 809, 480-484 .
Burkbardt, M. A., & Natbaniel, A., K. (1998). Ethical principales. In M. A. Burkbardt, & A. K. Natbaniel, (Ed.). Ethics & Issues in contemporary nursing (pp. 39-61). New York: Delmar.
Blackhall, L. J., Frank, G., Murphy, S., & Michel, V. (2001). Bioethics in a different tongue: the case of truth-telling. Journal of Urban Health, 78(1), 59-71.
Butow, P. N., Dowsett, S., Hagerty, R., & Tattersall, M. H. (2002). Communicating prognosis to patients with metastatic disease:What do they really want to know. Supportive Care in Cancer, 10(2),161-168.
Creagan, E. T. (1994). How to break news--and no devastate the patient. Mayo Clinic Proceedings, 69(10), 1015-1017.
Caruso, A., Di Francesco, B., Pugliese, P., Cinanni, V., & Corlito, A . (2000). Information and awareness of diagnosis and progression of cancer in adult and elderly cancer patients. Tumori, 86(3), 199-203.
Denzin, N. K. (1989). The research act : A theoretical introduction to sociological methods (3rd ed.). Chicago: Aldine Pub. Co.
Doyle, D., Hanks, G. W. C., & MachDonald, N. (1998). Oxford textbook of palliative medicine (2nd ed.). New York: Oxford University.
Dunniece, U., & Slevin, E. (2000). Nurse''s experiences of being present with a patient receiving a diagnosis of cancer. Journal of Advanced Nursing, 32(3), 611-618.
EL-Ghazali, S. (1997). Is it wise to tell the truth, the whole truth and nothing but the truth to a cancer patient. Annals of the New York Academy of Sciences, 809, 97-108.
Emanuel, E. J., & Emanuel, L. L. (1992). Four models of the physician-patient relationship. Journal of the American Medical Association, 267(16), 2221-2226.
Fallowfield, L. (1993). Giving sad and bad news. Lancet, 341(8843), 476-478.
Fallowfield, L., Ford, S., & Lewis, S., (1994). Information preferences of patients with

cancer. 344(3), 1576.

Feldman, M. D., Zhang, J., & Cummings, S. R. (1999). Chinese and U.S. internists adhere to different ethical standards. Journal of General Internal Medicine, 14(8), 469-473.
Friedrichsen, M. J., Strang, P.M., & Carlsson, M.E. (2002). Cancer patients'' interpretations of verbal expressions when given information about ending cancer treatment. Palliative Medicine,16(4), 323-330.
Gillon, R. (1985). Autonomy and the principle of respect for autonomy. British Medical Journal, 290, 1806-1808.
Greipp, M.E. (1992). Greipp''s model of ethical decision making. Journal of Advanced Nursing, 17(6), 734-738.
Gesser, G., Wong, P. T., & Reker, G. T.,(1987)Death attitudes across the lifespan: the development and validationof the death attitudes profiles. Omega, 18(2), 113-118.
Grassi, L., Giraldi, T., Messina, E. G., Magnani, K., Valle, E., & Cartei, G. (2000). Physicians'' attitudes to and problems with truth-telling to cancer patients. Support Care in Cancer, 8(1), 40-45.
Hebert, P. C., Hoffmaster, B., Glass, K. C., & Singer, P.A. (1997). Bioethics for clinicians : 7. truth telling. Canadian Medical Association, 156(2), 225-228.
Horikawa, N., Yamazaki, T., Sagawa, M., & Nagata, T. (1999). The disclosure of information to cancer patients and its relationship to their mental state in a consultation-liaison psychiatry setting in Japan. General Hospital Psychiatry, 21(5), 368-373.
Horikawa, N., Yamazaki, T., Sagawa, M., & Nagata, T. (2000). Change in disclosure of information to cancer patients in a general hospital in Japan. General Hospital Psychiatry, 22(1), 37-42.
Hosaka, T., & Aoki, T. (1996). Depression among cancer patients. Psychiatry and Clinical Neurosciences, 50(6), 309-312.
Hu, W.Y., Chiu, T. Y., Chuang, R. B., & Chen, C.Y. (2002). Solving family-related barriers to truthfulness in cases of terminal cancer in taiwan. Cancer Nursing, 25(6), 486-492.
Iconomou, G., Viha, A., Koutras , A., Vagenakis , A. G., & Kalofonos, H. P. (2002). Information needs and awareness of diagnosis in patients with cancer receiving chemotherapy: a report from Greece, Palliative Medicine, 16(4), 315-321.
Jokiel, M., & Sikorska, E. (1990). Public opinion on informing patients about their cancer diagnosis in 1976 and 1986. Nowotwory, 40(1), 60-64.
Kinzbrunner, B. M. (2002). How to help patients access end- of- life care. In B. M. Kinzbrunner, N. J. Weinreb, J. S. Policzer, & B. D.Weiss, (Ed.). End-of-life care. New York: McGraw-Hill.
Kimchi, J., Polivka, B., & Stevenson, J. B. (1991). Triangulation: operational definitions. Nursing Research, 40(6), 364-366.
Klocker, J. G., Klocker-Kaiser, U., & Schwaninger, M. (1997). Truth in the relationship between cancer patient and physician. Annals of the New York Academy of Sciences,809, 56-65.
Kuuppelomaki, M., & Lauri, S. (1998). Ethical dilemmas in the care of patients with incurable cancer. Nursing Ethics: an International Journal for Health Care Professionals, 5(4), 283-293.
Kim, M. K., & Alvi., A. (1999). Breaking the bad news of cancer : the patient''s perspective. Laryngoscope , 109(7), 1064-1067.
Krisman-Scott, M. A. (2000). An historical analysis of disclosure of terminal status. Journal of Nursing Scholarship, 32(1), 47-52.
Kagawa-Singer, M., & Blackhall, L. (2001) Negotiating cross-cultural issue at the end of life. Journal of the American Medical Association, 286, 2993-3001.
Lin, C. C. (1999). Disclosure of the cancer diagnosis as it relates to the quality of pain management among patients with cancer pain in Taiwan. Journal of Pain and Symptom Management, 18(5), 331-337.
Lavrentiadis, G., Manos, N., Christakis, J., & Semoglou, C. (1988). The Greek cancer patient''s knowledge and attitudes towards his diagnosis and prognosis. Psychotherapy & Psychosomatics, 49(3-4), 171-178.
Luce, J. M. (1990). Ethical principles in critical care. The Journal of American Medical Association, 263(5), 696-700.
Loge, J. H., Kassa, S., & Hytten, K. (1997). Disclosing the cancer diagnosis : the patients'' experiences. European Journal of Cancer, 33(6), 878-882.
Meredith, C., Symonds, P., Webster, L., Lamont, D., Pyper, E., Gillis, C. R., & Fallowfield, L. (1996). Information needs of cancer patients in west Scotland: cross sectional survey of patients'' views. British Medical Journal, 313(7059), 724-726.
Marwit, S. J., & Datson, S. L. (2002). Disclosure preferences about terminal illness : an examination of decision-related factors. Death Studies, 26(1), 1-20.
Mizuno, M., Onishi, C., & Ouishi, F. (2002). Truth disclosure of cancer diagnoses and its influence on bereaved Japanese families. Cancer Nursing, 25(5), 396-403.
Novack, D. H., Plumer, R., Smith, R.L., Ochitill, H., Morrow, G.R., & Bennett, J. M. (1979). Changes in physicians’ attitudes toward telling the cancer patient. The Journal of American Medical Association, 241(9), 897-900.
Pellegrino, E. D. (1988). Clinical ethics: biomedical ethics at the bedside. The Journal of American Medical Association, 260(6), 837-839.
Pallson, M. B., & Norberg, A. (1995). Breast cancer patients'' experiences of nursing care with the focus on emotional support : the implementation of a nursing intervention. Journal of Advanced Nursing, 21(2), 277-285.
Pronzato, P., Bertelli G., Losardo, P., & Landucci, M. (1994). What do advanced cancer patients know of their disease: a report from Italy. Supportive Care in Cancer, 2(4), 242-244.
Primentel, F. L., Ferreira, J. S., Vila Real, M., Mesquita, N. F., & Maia-Goncalves, J. P. (1999). Quantity and quality of information desired by portuguese cancer patients. Supportive Care in Cancer, 7(6), 407-412.
Parker, P. A., Baile,W. F., de Moor, C., Lenzi, R., Kudelka, A . P., & Cohen, L. (2001). Breaking bad news about cancer :patients'' preferences for communication. Journal of Clinical Oncology, 19(7), 2049-2056.
Phungrassami, T., Sriplung, H., Roka, A., Mintrasak, E., Peerawong, T., & Aegem, U. (2003). Disclosure of cancer diagnosis in Thai patients treated with radiotherapy. Social Science & Medicine, 57(9), 1675-1682.
Razavi, D., Delvaux, N., & Hapwood, P. (1997). Improving communication with cancer patients. A challenge for physicians. Annals of the New York Academy of Sciences, 809, 350-360.
Saunders, C. M. (1978). Appropriate treatment,appropriate death. In The management of terminal disease (pp. 1-9). London: Arnold.
Streubert, H. J. (1995). Qualitative research in nursing : advancing the humanistic imperative. Philadelphia : Lippincott.
Seo, M., Tamura, K., Shijo,H., Morioka,E., Ikegame, C., & Hirasako, K. (2000). Telling the diagnosis to cancer patients in Japan : Attitude and perception of patients, physicians and nurses. Palliative Medicine, 14(2), 105-110.
Schofield, P. E., Beeney, L. J., Thompson, J. F., Butow, P.N., Tattersall, M. H. N., &

Dunn, S. M. (2001). Hearing the bad news of a cancer diagnosis : the australian

melanoma patient''s perspective. Annals of Oncology, 12(3), 365-371.

Thomsen, O. O., Wulff, H. R., Martin, A., & Singer, P. A. (1993). What do gastroenterologists in Europe tell cancer patients. Lancet, 341(8843), 473-476.
Uchitomi, Y., & Yamawaki, S. (1997). Truth-telling practice in cancer care in Japan. Annals of The New York Academy of Sciences ,809 , 290-299.
Vegni, E., Zannini,L., Visioli, S., & Moja, E.A. (2001). Giving bad news: a GPs'' narrative perspective. Supportive Care in Cancer, 9(5), 390-396.
Yeung, E. W., French,P., & Leung, A. O. (1999). The impact of hospice inpatient care on the quality of life of patients terminally ill with cancer. Cancer Nursing, 22(5), 350-357.
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1. 李惠玲、湯梅芬、黃香香 (1994)。癌症病人家屬在照顧病人住院期間的壓力與因應行為。國防醫學,19(5),485-489。
2. 邱泰源 (1995b)。談我國安寧及緩和醫療照護的重要課題-與日本的比較。護理新象,5(4),8-13。
3. 邱泰源 (1995 a)。終末期照顧的醫病關係-倫理觀。醫學繼續教育,5(3),294-299。
4. 汪素敏、顧乃平 (2000)。照顧瀕死病人的倫理考量。國防醫學,31(1),72-78•
5. 姜安波 (1993)。重症醫療倫理綜論,內科學誌,4(4),263-278。
6. 許禮安 (1998)。臨終關懷之我見,應用倫理研究通訊,8,8-12。
7. 許禮安 (2002)。病情世界初探-由病情告知談起。安寧療護雜誌,7(3),239-250。
8. 許町子、杜異珍 (1997) 癌症病患和家屬對安寧照顧需求之探討。榮總護理,14(1),
9. 黃和美 (1985)。癌症末期病人對死亡心理反應知探討。護理雜誌,32(4),57-69。
10. 陳彰惠 (1982)。探討癌症患者之家屬對「告訴病人真相」的態度。護理雜誌,29(3),29-38。
11. 陳榮基 (1997)。不予及撤除治療的法律及倫理層面的探討。醫事法學,9(1),15-17。
12. 游翁斌、周稚傑、陳永煌 (1999)。重大病情之披露。國防醫學,28(6),491-494。
13. 楊克平、尹祚芊 (1999)。癌末病患健康相關生活品質內涵之研究。護理研究,7(2),129-143。
14. 潘湘如、杜明勳 (1997)。癌病病情告知。基層醫學,15(7),145-148。
15. 趙可式 (2000)。第八次南區安寧療護院際研討會-臨終病人的病情告知。安寧照顧會訊,39,27-31。
 
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