Firth P
Family Support, Isabel Hospice, Watchmead, Welwyn Garden City, UK.
Recent Results Cancer Res. 2006;168:61-71. doi: 10.1007/3-540-30758-3_6.
The focus of this chapter is on how clinicians can understand and communicate with the families of patients suffering from cancer. Most doctors and nurses do not have training in this area and are uncomfortable when conducting interviews with whole families. The need to extend our skills in the family context reflects the changes in the way care is provided to patients with a serious illness. We recognise the part families play in providing care and the subsequent effects on family life. The influence of systemic thinking and social construction theories has led to the acknowledgement that we are all part of systems which interact with each other and it is no longer appropriate to see the patient in isolation. The chapter will look at ideas from family therapy which can help us assess and intervene when necessary. The patient suffering from a life-threatening illness such as cancer looks to his family and friends for care and support. The management and course of the illness is affected by the involvement of the family and how they manage the stress and the effects of illness on a family member (Wright and Leahey 2000). Duhamel and Dupuis (2003) point out that there are three important factors in the management of the illness: the effects of family stress, the needs of the family as caregivers, and the effects of the role and how the family cope with the way the patient experiences his illness. This presents professionals working in the field with challenges they are often ill-equipped to deal with. Most healthcare workers have inadequate training in understanding family dynamics and even less knowledge about how to communicate effectively with whole families. Consequently, many healthcare professionals avoid couple and family interviews, feeling inadequate and helpless like the families themselves. I will address some of these issues in the chapter, firstly by examining what we now regard as the family and then by using ideas from systemic theory I will look at assessing families, the organisation of families and belief systems, concluding with communications which can bring about change in families needing our help. Families are complex, they have histories and are influenced by the past. Relationships within families have different meanings and significance not understood unless questions that we ask bring access to them; moreover, their journeys through the illness of the family member is different from that of the patients. However, the need for support/information/valuing/respect is the same. If we are to help, we need to know how to approach families, how to asses their needs, and learn about interventions that help so that we can offer holistic care which will ease the practical, physical, emotional, social and spiritual pain and suffering of the people who will go on living with the significance of the death.
本章的重点是临床医生如何理解癌症患者的家属并与他们进行沟通。大多数医生和护士并未接受过这方面的培训，在与患者全家进行面谈时会感到不自在。我们需要在家庭环境中拓展技能，这反映了为重症患者提供护理方式的变化。我们认识到家庭在提供护理方面所起的作用以及对家庭生活的后续影响。系统思维和社会建构理论的影响使我们认识到，我们都是相互作用的系统的一部分，孤立地看待患者已不再合适。本章将探讨家庭治疗中的一些理念，这些理念可以帮助我们在必要时进行评估和干预。患有癌症等危及生命疾病的患者会向家人和朋友寻求护理和支持。疾病的管理和病程会受到家庭参与程度的影响，以及他们如何应对压力和疾病对家庭成员的影响（赖特和利希2000年）。杜哈梅尔和迪皮伊（2003年）指出，疾病管理中有三个重要因素：家庭压力的影响、作为照顾者的家庭需求、角色的影响以及家庭应对患者患病体验方式的情况。这给该领域的专业人员带来了挑战，而他们往往对此准备不足。大多数医护人员在理解家庭动态方面的培训不足，对于如何与患者全家进行有效沟通的了解更少。因此，许多医护人员回避与夫妻及全家的面谈，感觉自己像患者家属一样能力不足且无助。我将在本章中探讨其中一些问题，首先审视我们现在所认为的家庭，然后运用系统理论的理念来探讨对家庭的评估、家庭结构和信仰体系，最后讲述能够促使需要我们帮助的家庭发生改变的沟通方式。家庭是复杂的，它们有自己的历史，并受过去的影响。家庭内部的关系有着不同的意义和重要性，除非我们提出的问题能让我们了解到这些，否则就无法理解；此外，他们在家庭成员患病过程中的经历与患者不同。然而，他们对支持、信息、重视和尊重的需求是相同的。如果我们要提供帮助，就需要知道如何与家庭打交道，如何评估他们的需求，了解哪些干预措施会有帮助，以便我们能够提供全面的护理，减轻那些将带着亲人死亡的意义继续生活的人的实际、身体、情感、社会和精神上的痛苦。
