前言：癌症已蟬聯40多年台灣十大死因之冠，癌症診斷常使得病人與死亡間的連結更為強烈，且病人於罹病過程因治療需求反覆入院，有較高的機率曝觸於他人死亡情境，而產生莫大衝擊。現存研究鮮少探討華人社會下於醫院經歷他人死亡經驗的病人觀點，且臨床上對此情境無相關照護指引，華人文化忌談死亡致使事件後所產生的心理影響未被關注。故本研究旨在探討癌症病人於住院中經歷鄰床病人死亡之經驗及照護需求。
研究方法：本研究採描述現象學，採方便取樣收錄13名曾於住院期間經歷鄰床病人死亡的癌症病人，進行半結構式訪談，過程中進行錄音以確保資料的完整性，並依照Colaizzi現象學分析法分析文本資料，歸納出主題現象，遵循研究可信性、可靠性、遷移性及可驗證性四項指標確保質性研究嚴謹度，直到資料達飽和亦即無新資料產生方停止資料收集。
研究結果：癌症病人於住院期間經歷鄰床病人死亡之經驗共歸納出4大主題：淪為死亡的旁觀者、無聲的情感體驗、對生死的省思、沖犯個人運氣；以及2大照護需求主題：緩衝保護閃避忌諱、我也是有需求的病人!研究發現癌症病人默默、被擱置在旁經歷他人死亡的處境，在過程中會與他人死亡事件產生連結，情緒上受波動及對生死有更深的省思及體悟，而在事件中沉默的病人，期盼外界可主動提供協助，以降低事件對自身的影響。
結論：癌症病人於住院期間經歷鄰床病人死亡時會產生正、負向感受及影響，其在事件發生前、中、後亦具有相關照護需求，本研究可作為醫療照護者協助正經歷瀕死、死亡事件的癌症病人提供具文化適切性照護之參考依據。

Introduction: Cancer has consistently ranked as the leading cause of death in Taiwan for over 40 years. In the social imaginary, cancer is associated with a death sentence, and the diagnosis of cancer intensifies the connection between patients and death. There are 51.1% death events occurring in hospitals in Taiwan. When facing the event of death, individuals often exhibit a range of positive and negative emotional responses and behavioral reactions, often necessitating adaptive coping strategies. Cancer patients require hospitalization for treatment regularly, resulting in a higher probability of exposure to death events, which can have profound psychological impacts. Current research rarely explores the perspectives of patients in Chinese society who experience the deaths of others in hospitals. Additionally, there are no relevant clinical care guidelines for this situation, and the cultural taboo around discussing death in Chinese culture has led to the neglect of the psychological effects following such events. Therefore, this study aims to explore cancer patients’ lived experience of undergoing fellow patients’ deaths during hospitalization.
Methods: This study adopted a descriptive phenomenological approach. Convenience sampling was used. Inclusion criteria: (1) those who were diagnosed with cancer by a physician, (2) those who have experienced a fellow patient’s death in the past year, (4) have clear consciousness and can communicate in Mandarin and Taiwanese, (4) those who are over 20 years old and agreed to participate in this study to share their experience and complete the consent form. Exclusion criteria: those who were diagnosed with psychiatric disorders or cognitive impairments by a physician. Data collection occurred from January 2023 to June 2023, and face-to-face semi-structured interviews were conducted to explore their experiences, which were tape-recorded. After data saturation, signifying no new units of meaning emerged, we stopped collecting data. Colaizzi's phenomenological method was used to analyze the data and reveal the emergent themes and subthemes. In the data analysis process, we used peer debriefing and member check to avoid researcher's subjective bias in data results. We followed four indicators (credibility, dependability, transferability, and confirmability) to ensure the rigour of qualitative research.
Results: The data collection period is from January 2023 to June 2023. The study participation rate is 52 %. We enrolled 13 cancer patients who encountered fellow patient’s death during hospitalization in the southern medical center in Taiwan. The average age of the 13 participants was 56 years, 9 of whom were male. They were diagnosed with cancer at stage II or higher. Religious beliefs include general folklore religion (n=4), Buddhism(n=2), Taoism (n=5), and no belief (n=1). Four major themes about the experience emerged from the patients’ interviews: (1) Trapped in being a bystander of death; (2) Feelings and emotions aroused in silence; (3) Reflection on life and death; (4) Offending the personal luck. Two major themes were about the care needs: (1) Need to move away from taboos related to death; (2) I am also a patient with needs! We found that participants have a chance to realize the process from life to death in the experience, which led them to reflect on their illness and mortality. They had a range of emotions and feelings when witnessing someone's death. The interview data showed that they had care needs during the death events, but they always kept in silence, potentially leading to being overlooked.
Conclusion: This study found that the death event had positive and negative effects on cancer patients. Despite their awareness of the care need during the death event, they always remained silent, which highlighting the taboo against death in Chinese culture. And the death not only generated the various emotions and feelings but also serving as a trigger to prompt cancer patients to contemplate life and death. They realized the naturality of death and the finitude of life and started to think about their death in the future. Maybe it would be a chance to discuss about the death with patients under the taboo against death. Most important of all is that the medical staff should notice the patient’s care needs and take the initiative to provide assistances with individualized care to decrease the impact from the death event during hospitalization. This study can be used as a reference for medical caregivers to assist cancer patients who are undergoing others’ death during hospitalization in providing culturally appropriate care. However, there’re several limitations in this study. The study was conducted at a medical center in southern Taiwan. Participants diagnosed with cancer were mostly adults with Stage II or above cancer, and there’re lack perspectives from Catholics and Christians. Because of cancer treatment or symptom control during hospitalization, some of them were too weak to withstand lengthy interviews. For further studies, it is recommended to conduct research in hospitals in different regions and levels. Additionally, it is interesting to explore different types of diseases and family members’ perspectives in experiencing the death event in hospitals and how the event influences patient’s medical decisions and their views on life and death.

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