末期癌症病人靈性安適感與症狀的相關性

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題名:	末期癌症病人靈性安適感與症狀的相關性
作者:	王映之
貢獻者:	護理學研究所
關鍵詞:	癌症症狀
日期:	2010
上傳時間:	2010-10-21 10:16:07 (UTC+8)
摘要:	Abstract Title of Thesis: Relationships between Spiritual Well-being and Symptoms in Advanced Cancer Patients Institution: Graduate Institute of Nursing, Taipei Medical University Author: Yin-Chih Wang Thesis directed by: Chia-Chin Lin, Ph. D., Professor Objectives: The purpose of current research is to explore the relationships between spiritual well-being and symptoms in advanced cancer patients, and also to clarify the mechanism how spiritual well-being reduce the impacts on quality of life, hopelessness and desire for hastened death caused by cancer-related symptoms as a buffer. Methods:This is a cross-sectional designed study, Eighty five with mixed diagnoses advanced cancer patients have been recruited, and completed Taiwanese version of the M. D. Anderson Symptom Inventory (MADSI-T), the Functional Assessment of Chronic Illness Therapy－Spiritual Well-being (FACIT-Sp), the Beck hopelessness Scale (BHS) and the Schedule of Attitudes Toward hastened Death (SAHD). Results: Spiritual well-being demonstrated a significant , negative with symptom severity (r=- .46) and symptom interfere(r=- .56); symptom severity and symptom interfere is also correlated with hopelessness(r= .51, r= .61) and desire for hastened death(r= .53, r= .53). A regression analyse assessed by generalized linear model showed spiritual well-being is a partial mediator to the three relations of symptom burden versus quality of life, hopelessness and desire for hastened death. However, spiritual well-being is a moderator to symptom burden versus quality of life only, but there is not a significance to symptom burden versus hopelessness and desire for hastened death. Sleep problems are most annoying to terminally cancer patients, however, patients with high levels of spiritual well-being had lower symptom severity and interferece to daily life. After controlled symptom burdens and other confounders(e.g. age, sex, current job situation…), meaning/peace domain of spiritual well-being is more important to quality of life, hopelessness and desire for hastened death than faith domain. Conclusion: The current study results lead further understand to the relationships between spiritual well-being and cancer related symptoms. As a mediator and moderator, spiritual well-being can reduce the negative impacts caused by cancer symptoms. It is concluded that these results support the move to biopsychosocialspiritual model for holistic palliative care. Key words: cancer-related symptoms, spiritual well-being
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描述:	(一)論文目次目錄致謝 ………………………………………………………………………… I 中文摘要 ………………………………………………………………………… II 英文摘要 ………………………………………………………………………… III 目錄 ………………………………………………………………………… IV 圖表目次 ………………………………………………………………………… V 第一章序論…………………………………………………………………… 1 第一節研究動機……………………………………………………………… 1 第二節研究重要性…………………………………………………………… 4 第三節研究目的……………………………………………………………… 6 第二章文獻查證……………………………………………………………… 7 第一節癌症症狀……………………………………………………………… 7 第二節靈性安適感…………………………………………………………… 11 一靈性安適感的相關概念……………………………………………… 12 二靈性安適感的概念架構……………………………………………… 18 三靈性安適感的測量工具……………………………………………… 20 第三章研究方法……………………………………………………………… 22 第一節研究設計……………………………………………………………… 22 第二節研究架構……………………………………………………………… 23 第三節研究假說……………………………………………………………… 25 第四節名詞界定……………………………………………………………… 26 第五節研究場所及研究對象………………………………………………… 27 第六節研究工具及其信效度………………………………………………… 28 一人口學調查資料表…………………………………………………… 28 二中文版安德森症狀量表……………………………………………… 28 三繁體中文版癌症治療功能性評估生活品質量表…………………… 29 四慢性疾病治療功能評估靈性安適感量表…………………………… 31 五貝克絕望感量表……………………………………………………… 34 六加速死亡意念態度量表……………………………………………… 35 第七節研究進行步驟………………………………………………………… 38 第八節資料處理與分析……………………………………………………… 40 第四章研究結果分析………………………………………………………… 42 第一節研究對象基本屬性之描述性統計…………………………………… 42 第二節癌末病人症狀困擾、靈性安適感、生活品質、絕望感以及自殺意念支線況描述性分析…………………………………………………… 46 一癌末病人之症狀困擾………………………………………………… 46 二癌末病人之靈性安適感……………………………………………… 47 三癌末病人之生活品質………………………………………………… 47 四癌末病人之絕望感…………………………………………………… 47 五癌末病人之加速死亡意念…………………………………………… 48 第三節癌末病人之症狀困擾與靈性安適感及症狀困擾與生活品質、絕望感、加速死亡意念之相關性…………………………………………… 55 一癌末病人之症狀困擾與靈性安適感及靈性安適感次量表之相關性分析…………………………………………………………………… 55 二癌末病人之症狀困擾、靈性安適感與生活品質之相關性分析…… 55 三癌末病人之症狀困擾與絕望感、加速死亡意念之相關性分析…… 56 四癌末病人之靈性安適感與絕望感、加速死亡意念之相關性分析…… 56 第四節靈性安適感之中介作用及調節作用………………………………… 61 一靈性安適感的中介作用之統計分析………………………………… 61 二靈性安適感的調節作用之統計分析………………………………… 89 第五章討論…………………………………………………………………… 93 第一節癌末病人的症狀困擾與靈性安適感程度之統計分析……………… 93 第二節癌末病人的症狀困擾與靈性安適感以及症狀困擾與生活品質、絕望感、加速死亡意念之相關性…………………………………………… 99 一癌末病人症狀困擾與靈性安適感之相關性………………………… 99 二癌末病人症狀困擾、靈性安適感與生活品質、絕望感、加速死亡意念之相關性…………………………………………………………… 103 第三節癌末病人靈性安適感在症狀活品質、絕望感以及加速死亡意念間調節效果和中介效果…………………………………………………… 107 第六章結論與建議…………………………………………………………… 110 第一節結論…………………………………………………………………… 110 第二節研究限制……………………………………………………………… 112 第三節建議…………………………………………………………………… 114 參考文獻 ………………………………………………………………………… 116 參考書籍 ………………………………………………………………………… 126 參考網路 ………………………………………………………………………… 127 研究附錄附錄一人口學資料調查表…………………………………………………… 128 附錄二台灣版安德森症狀量表……………………………………………… 129 附錄三 FACT-G 生活品質量表……………………………………………… 131 附錄四 FACIT-Sp靈性安適感量表…………………………………………… 133 附錄五貝克絕望感量表……………………………………………………… 134 附錄六中文翻譯版加速死亡態度意念量表………………………………… 135 附錄七加速死亡態度意念量表之專家效度問卷…………………………… 136 圖表目次圖一莫伯格靈性安適之概念架構圖…………………………………………… 19 圖二末期癌症病人靈性安適感與症狀相關性研究架構圖…………………… 24 圖三靈性安適感於症狀嚴重程度與生活品質關係間之部分中介作用……… 67 圖三續靈性安適感於症狀對日常生活干擾嚴重程度與生活品質關係間之部分中介作用…………………………………………………………………… 66 圖四靈性安適感於症狀嚴重程度與絕望感關係間之部分中介作用………… 73 圖四續靈性安適感於症狀對日常生活干擾嚴重程度與絕望感關係間之部分中介作用……………………………………………………………………… 74 圖五靈性安適感於症狀嚴重程度與加速死亡意念關係間之部分中介作用… 79 圖五續靈性安適感於症狀對日常生活干擾嚴重程度與加速死亡意念關係間之部分中介作用……………………………………………………………… 80 圖六靈性安適感於症狀嚴重程度與生活品質關係間之調節作用…………… 85 圖六續靈性安適感於症狀對日常生活干擾嚴重程度與生活品質關係間之調節作用………………………………………………………………………… 86 表一統計方法…………………………………………………………………… 41 表二研究對象基本屬性、疾病個性之描述性統計…………………………… 44 表三症狀嚴重程度之描述性統計……………………………………………… 49 表三續症狀對日常生活干擾嚴重程度之描述性統計………………………… 50 表四癌末病人靈性安適感描述性統計………………………………………… 51 表五癌末病人生活品質描述性統計…………………………………………… 52 表六癌末病人絕望感描述性統計……………………………………………… 53 表七癌末病人加速死亡意念描述性統計……………………………………… 54 表八癌末病人之症狀困擾與靈性安適感之相關性…………………………… 57 表九癌末病人之症狀困擾、靈性安適感與生活品質之相關性……………… 58 表十癌末病人之症狀困擾與絕望感、加速死亡意念之相性………………… 59 表十一癌末病人之靈性安適感與絕望感、加速死亡意念之相關性…………… 60 表十二靈性安適感於症狀嚴重程度與生活品質關係之中介…………………… 65 表十二續靈性安適感於症狀對日常生活干擾嚴重程度與生活品質關係之中介作用…………………………………………………………………………… 66 表十三靈性安適感於症狀嚴重程度與絕望感關係之中介作用………………… 71 表十三續靈性安適感於症狀對日常生活干擾嚴重程度與絕望感關係之中介作用…………………………………………………………………………… 72 表十四靈性安適感於症狀嚴重程度與加速死亡意念關係之中介作用………… 77 表十四續靈性安適感於症狀對日常生活干擾嚴重程度與加速死亡意念關係之中介作用……………………………………………………………………… 78 表十五靈性安適感於症狀嚴重程度與生活品質關係之調節作用……………… 83 表十五續靈性安適感於症狀對日常生活干擾嚴重程度與生活品質關係之調節作用…………………………………………………………………………… 84 表十六靈性安適感於症狀嚴重程度與絕望感關係之調節作用的驗證………… 88 表十六續靈性安適感於症狀對日常生活干擾嚴重程度與絕望感關係之調節作用的驗證……………………………………………………………………… 89 表十七靈性安適感於症狀嚴重程度與加速死亡意念關係之調節作用的驗證… 91 表十七續靈性安適感於症狀對日常生活干擾嚴重程度與加速死亡意念關係之調節作用的驗證……………………………………………………………… 92 (二)參考文獻參考文獻呂美嬅(2001) ‧放鬆反應於改善癌症末期病患之疼痛程度、情緒狀態及生理反應之成效。未發表碩士論文，臺北醫學大學護理學系，台北。胡文郁、戴玉慈、陳慶餘、陳月枝(2003)．生活品質之概念分析－於探討癌末病人健康相關生活品質之應用‧安寧療護，8(1)，45-60. 張愛萍(2002) ‧發展台灣版簡明疲憊量表(BFI-Taiwan Form)與台灣版安德森症狀量表(MDASI-Taiwan Form)及信效度檢測‧未發表碩士論文，臺北醫學大學護理學系，台北。黃淑鶴(1999) ‧音樂治療於改善癌症末期病患疼痛及症狀困擾之成效‧未發表碩士論文，臺北醫學大學護理學系，台北。賴維淑(2001) ‧晚期癌症病患對臨終事件之感受與身、心、社會及靈性之需求‧未發表論文，國立成功大學護理研究所，台南。蘇淑芬（2002）‧中文版靈性安適量表信度和效度檢定‧未發表的碩士論文，長庚大學護理學系，桃園。 Ando, M., Morita, T., Okamoto, T., Ninosaka, Y. (2008). One-week hort-Term Life Review interview can improve spiritual well-being of terminally ill cancer patients. Psycho-Oncology. 17, 885-890. Alexander, C. N., Robinson, D. W., Orme-Johnson, R. H., Schneider, R. H., & Walton, K. G. (1994). The effects of transcendental mediation compared to other methods of relaxation and mediation reducing risk factors, morbidity, and mortality. Homeostasis, 35, 243-264. Astrow, A. B., Wexler, A., Texeira, K., He, M. K., Sulmasy, D. P. (2007). Is Failure to Meet Spiritual Needs Associated With Cancer Patients’ Perceptions of Quality of Care and Their Satisfaction With Care? J Clin Oncol, 25(36), 5753-7. Baetz, M., Bowen, R. (2008). Chronic pain and fatigue: Associations with religion and Spirituality. Pain Res Manage, 13(5), 383-388. Balboni, T. A., Vanderwerker, L. G., Block, S. D., Paulk, M. E., Lathan, C. S., Peteet, J. R., Prigerson, H. G. (2007). Religiousness and Spiritual Support Among Advanced Cancer Patients And Associations With End-of-Life Treatment Preferences and Quality of Life. J Clin Oncol. 25(5), 555-60. Baron, R. M., Kenny, D. A. (1986). The moderator-Mediator Variable Distinction in Social Psychological Research: Conceptual, Strategic, and Statistical Consideration. Journal of personality and Social Psychology. 51(6), 1173-1182 Bleijenberg, G. (2009). Psychosocial interventions for reducing fatigue during cancer treatment in adults (Review), Cochrane Database of Systematic Reviews, 2, 1-67. Brady, M. T., Peterman, A. H., Fitchett, G., Mo, M., Cella, D. (1999). A case of including spirituality in quality of life measurement in oncology. Psychoonchology.8, 417-428. Breitbart, W.(2001).Spirituality and meaning in supportive care: Spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Supportive care in Cancer, 10(4), 272-80. Breitbart, W., Rosenfeld, B., Pession, H., Kaim, M., Funesti-Esch, J., Galietta, M., Nelson, C. J., et al. (2000). Depression, Hopelessness, and Desire for Hastened Death in Terminally Ill Patients With Cancer. JAMA, 284(22), 2907-2911. Cella, D.F. (1997). Manual of the functional assessment of chronic illness therapy (FACIT scales). Evanston, IL: Center on Outcomes, Research and Education (CORE), Evanston Northwestern Healthcare and Northwestern University. Version 4. Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., et al., (1993). The Functional Assessment of Cancer Therapy Scale: Development and Validation of the General Measure. Journal of Clinical Oncology, 11(3), 570-579. Cella, D. F. & Cherin, E.A. (1988). Quality of life during and after cancer treatment. Compr Ther. 4, 69-75. Chang, V. T., Hwang, S. S., Feuerman, M., & Kasimis, B. S. (2000). Symptom and quality of life survey of medical oncology patients at a veterans affairs medical center: a role for symptom assessment. Cancer, 88(5), 1175-83. Charlotte, C.A. (2001). Symptoms management at the end of life. J Am Osteopath Assoc. 101(10), 609-15. Cha, V. T., Hwang, S. S., Feuerman, M., Kasimis, B. S. (2000). Symptom and quality of life survey of medical oncology patients at a Veterans Affairs medical center: A role for symptom assessment. Cancer. 88(5), 1175 – 1183. Cleeland, C. S. (2007). Symptom burden: multiple symptoms and their impact as patient-reported outcomes. J Natl Cancer Inst Monogr, 37, 16-21. Cleeland, C. S., Bennett, G. J., Dantzer. R., Dougherty, P. M., Dunn. A. J., Meyers, C. A., et al. (2003). Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of cancer symptoms. Cancer, 97(11), 2919-25. Cleeland, C. S., Mendoza, T. R., Wang, X. S., Chou, C., Harle, M. T., Morrissey, M., & Engstrom, M. C. (2000). Assessing symptom distress in cancer patients: The M. D. Anderson Symptom Inventory. Cancer, 89(7), 1634-1646. Edward, J., Stepanski, Helen, J., Burgess, (2007). Sleep and Camcer. Sleep Med Clin. 2, 67-75. Eisemann, M., Lalos, A.(1999). Psychosocial determinants of Well-being in gynecologic cancer patients. Cancer Nurs. 22(4), 303-6. Ellison, C. W. (1983). Spiritual wellbeing: conceptualization and measurement. Journal of Psychology and Theology. 11(4):330-340. Ellison. C. W., Smith, J (1991). Toward an integrative measure of health and well-being. J. Psychol. Theol. 19(1), 35-48. Ellison, C. W., (1983). Spiritual wellbeing: conceptualization and measurement. Journal of Psychology and Theology. 11(4):330-340. Engel, G. L. (1980). The Clinical application of the biopsychosocial model. Am. J. Psychiatry. 137, 535-544. Ferrell, B. R., Grant, M., Funk, B., Otis-Green, S., Garcia, N. (1998). Quality of Life in breast cancer: Part II: Psychological and spiritual Well-Being. Cancer Nurs. 21(1), 1-9. Fitchett, G., Peterman, A. H. and Cella, D. F. (1996). Spiritual Beliefs and Quality of Life in Cancer and HIV Patients. Paper presented at the Third World Congress of Psycho-Oncology, New York, New York. Fortner, B. V., Stepanski, E. J., Wang, S.C., Kasprowicz, S. Durrence, H.H. (2002). Sleep and Quality of Life in Breast Cancer Patients. J Pain Symptom Manage. 24, 471-480. Goedendorp, M. M., Gielissen, M. F. M., Verhagen, CAHHVM., Grabsch, B., Clarke, D. M., Love, A., et al.(2006). Psychological morbidity and quality of life in women with advanced breast cancer: a cross-sectional survey. Palliat Support Care. 4(47), 47-56. Harrison, J. (1993). Spirituality and nursing practice. Journal of Clinical Nursing.2, 211-217. Hedstrom, M., Ljungman, G., Essen, L. (2005). Perceptions of Distress Among Adolescents Recently Diagnosed With Cancer. J Pediatr Hematol Oncol. 27(1), 15-22. Hiatt, J. F. (1986). Spirituality, medicine, and healing. South Med. J. 79, 736-743. Jones, J.M., Huggins, M.A., Rydall, A.C., & Rodin, G. M. (2003). Symptomatic distress, hopelessness, and the desire for hastened death in hospitalized cancer patients. Journal of Psychosomatic Research. 55, 411-418. Manning-Walsh, J. (2005). Social Support as a Mediator Between Symptom Distress and Quality of Life in Women With Breast Cancer. JOGNN, 34, 82-493. McClain, C. S., Rosenfeld, B., Breitbart, W. (2003). Effect of spiritual Well-Being on end-of-life despair in terminally-ill cancer patients. The Lancet, 361, 1603-1607. McSherry, W. (1996) Raising the spirits. Nursing Times, 92(3), 48-49. Moberg, D. O., & Brusek, P. M. (1978). Spiritual well-being: A neglected subject in quality of life research. Social Indicators Research, 5, 303-323. Mystakidou, K., Parpa, E., Katsouda, E., Galanos, A., Vlahos, L. (2005). Pain and Desire for hastened Death in Terminally Camcer Patients. Cancer Nursing. 28(4), 318-324. Mystakidou, K., Parpa, E., Tsilika, E., Pathiaki, M., Galanos, A., Vlahos, L. (2007). DEPRESSION, HOPELESSNESS, AND SLEEP IN CANCER PATIENTS’ DESIRE FOR DEATH. INT’L J. PSYCHIATRY IN MEDICINE. 37(2), 201-211. Mytko, J. J., Knight, S. J. (1999). Body, Mind and spirit: Towards the intergration of religiosity and spirituality cancer quality of life research. Psycho-Oncology. 8:439-450 National Institute for Healthcare Research. (1997). Final Report. Scientific Progress in Spiritual Research. NIHR, Rockville, MD. Nelson, C. J., Rosenfeld, B., Breitbart, W., Galietta, M. (2002). Spirituality, Religion, and Depression in the Terminally Ill. Psychomatics. 43:3, 213-219 Nissim, R., Flora, D. B., Cribbie, R.A., Zimmermann, C., Gagliese, L., Rodin, G. (2009). Factor structure of the Beck Hopelessness Scale in individuals with advanced cancer. Psycho-Oncology. Karasu, B. T. (1999) Spiritual psychotherapy. Am J Psychother. 53, 143-162. Kass, J. D., Friedman, R., Leserman, J., Zuttermeister, P.C. and Bemson, H. (1991). Health outcomes and a new index of spiritual experience. J. Sci. Study Religion. 30(2), 203-211. Gustafsson, G., Langemark, F., Wesenberg, F. et al.(2004). Childhood Cancer in the Nordic Countries. Report on Epidemiologic and Therapeutic Results from Registries and Working Groups. NOPHO Annual Meeting Odense. Lacasse, C., Beck, S.L. (2007). Clinical assessment of symptom clusters. Seminars in Oncology Nursing. 23, 106-112. Levy, M. (2008). Cancer fatigue: a review for psychiatrists. General Hospital Psychiatry. 30, 233-244. Lin, C.C., Chang, A.P., Cleeland, C.S., Mendoza, T.R., Wang, X.S. (2007). Taiwanese Version of the M.D. Anderson Symptom Inventory: Symptom Assessment in Cancer Patients. J Pain Symptom Manage. 33(2),180-8. Paolini, C. A. (2001). Symptoms Management at the End of Life. End-of-Life Care. Peterman, AH., Fitchett, G., Brady, M.J., Hernandez, L., Cella, D. (2002). Meaning Spiritual Well-Being in People With Cancer: The Functional assessment of Chronic Illness Therapy－Spiritual Well-Being scale(FACIT-Sp). Ann Behav Med. 24(1), 49-58. Portenoy. R., Thaler, H. T., Kornblith, A. B., Lepore, J. M., Friedlander-Klar, H., Kiyasu, E., Sobel, D. et al., (1994). The Memorial Symptom Assessment Scale: an instrument for evaluation of symptom prevalence, characteristics and distress. Eur J Cancer[A]30, 1326-1336. Puchalski, C., Romer, A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med. 3, 129-137. Reyes-Gibby, C. C., Andy, L. A., Anderson, K. O., Mendoza, T. R., Cleeland, C.S. (2006). Pain, depression and fatigue in community-dwelling adults with and without a history of cancer. J Pain Symptom Manage. 32, 118-128. Reyes-Gibby, C. C., Wu, X., Spitz, M., Kurzrock, R., Fisch, M., Bruera, E., et al., (2008). Molecular epidemiology, cancer-related symptoms, and cytokines pathway. Lancet Oncol, 9,777-785. Rosenfeld, B., Breitbart, W., Galietta, M., Kaim, M., Funwsti-Esch, J., Pessin, H., Nelson, C. J., et al. (2000). The Schedule of Attitudes toward Hastened Death:Measuring Desire for death in Terminally Ill Cancer Patients. Cancer, 88(12), 2868-2875. Rosenfeld, B., Gibson, C., Kramer, M., Breitbart, W. (2004). Hopelessness and terminal illness: The construct of hopelessness in patients with advanced AIDS. Palliative and Supportive Care. 2, 43-53. Skerman, H. M., Yates, P.M., Battistutta, D. (2009). Multivariate Metods to Identify Cancer-Related Symptom Clusters. Research in Nursing & Health. 32, 345-360. Sun, V., Ferrell, B., Juarez, G., Wagman, L. D., Yen, Y., Chung, V. (2008). Symptom Concerns and Quality of Life in Hepatobiliary Cancer. Oncology Nursing Forum. 35(3). 45-52. Subdblom, D. M., Haikonen, S., Niemi-Pynttari, J., Tigerstedt, I. (1994). Effect Of Spiritual Healing on chronic Idiooathic Pain: A Medical and Psychological Study. The Clinical Journal of Pain. 10(4), 296-302. Thomason, C. L., Brody, H. (1999). Inclusive Spirituality. The Journal of Family Practice. 48, 96-97. Tseng, T. H., Cleenland, C.S., Wang, X. S., Lin, C.C. (2008). Assessing Cancer Symptoms in Adolescent With Cancer Using the Taiwanese Version of the M. D. Anderson Symptom Inventory. Cancer Nursing. 31(3), 9-16. Wachholtz, A. B., Pearce, M. J. Koenig, H. (2007). Exploring the Relationship between Spirituality, Coping, and Pain. J Behav Med. 30, 311-318. Whitford, H.S., Olver, L. N., Peterson, M. J. (2008). Spirituality as a core domain in the assessment of quality of life in oncology. Psycho-Oncology. 17:1121-1128. Zavala, M.W., Maliski, S. L., Kwan, L., Fink, A., Litwin, M. S. (2009). Spirituality and quality of life in low-income men with metastatic prostate cancer. Psycho-Oncology. 18: 753-761. 參考書籍 Janet A. M. (2001).Nursing as a Spiritual Practice: A Contemporary Application of Florence Nightingale’s Views. New York: Springer publishing. Macrae, J. A. (2001) ‧ Nursing as a Spiritual Practice‧New York, NY:Sprimger Publishing Company Narayanasamy, A. (1991). Spiritual Care: a resource guide. Quay Books, Lancaster Neuamn, B.(1989). The Neuman system model, 2nd edn. Appleton& Lange, Norwalk. Speck, P. (1998). Spiritual issues in palliative care. In D. Doyle, G. W. C. Hanks, & N. MacDolonald (Eds.), Oxford Textbook of Palliative Medicine (2nd ed., pp.805-814). New York: Oxford University Press. Stevens, M. M. (1998). Care of the dying child and adolescent : Family adjustment and support. In D. Doyle, G. W. C. Hanks, & N. MacDolonald (Eds.), Oxford Textbook of Palliative Medicine (2nd ed., pp.1071). New York: Oxford University Press. Stoll, R.I. (1989). The essence of spirituality. In: Carson, V.B. (ed) Spirituality dimensions of nursing practice. W.B. Saunders, Philasophia. Wilfred M. (2000). Making sense of Spirituality in Nursing Practice: An interactive Approach. London: Churchill Livingston 參考網路行政院衛生署(2002) ‧安寧緩和醫療條例‧2010年1月10 日，取自：http://dohlaw.doh.gov.tw/Chi/FLAW/FLAWDAT0202.asp M.D Anderson Cancer Center.2009 The M.D. Anderson Symptom. Inventory: UserGuide. Retrived January 21, 2010, from Http://www.mdanderson.org/education-and-research/departments-programs-and-labs/departments-and-divisions/symptom-research/symptom-assessment-tools/MDASI_userguide.pdf
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