The progress of awareness and acceptance of dying assessed in cancer patients and their caring relatives
The progress of awareness and acceptance of dying assessed in cancer patients and their caring relatives
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DOI：
10.1191/026921699672169546
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发表时间：
1999-01-01
影响因子：
4.4
通讯作者：
Hinton, J
中科院分区：
文献类型：
--
作者：
Hinton, J
通过对76名临终关怀癌症患者和关怀亲属的随机抽样，每周通过半结构化访谈评估对死亡的意识和接受程度。在研究的最后8周，患者的意识仅略有提高(约42%完全确定)，而亲属的确定程度明显提高(从53%确定到81%确定)。抑郁症与亲属的更多意识有关，但与患者无关。如果死亡似乎是可能的，而不是确定的，或者仅仅是可能的，患者会更焦虑。接受度通常会增加，51%的患者和69%的亲属几乎/完全接受。许多个体在认知和接受的平均进展上存在差异；18%的患者和24%的亲属表现出波动或下降的接受程度。患者和亲属的意识水平与接受水平呈正相关(r=0.46)和接受(r=0.47)。如果患者年龄超过70岁，身体虚弱，无法集中注意力或生活质量指数(QLI)低于5，亲属会接受更多，但如果患者是女性，如果QLI高于5，患者更容易接受。疼痛并没有增加接受度。接受从死亡的必然性、信仰和精神价值、生命的递减回报、完整的生命、最终的利益、幽默、分享等方面进行描述。个体经常使用不止一个概念。从这个样本中概括准确的数字需要谨慎，但一些进步的模式、可能的影响因素和接受的方式可能会广泛适用。
Awareness and acceptance of dying were assessed weekly by semistructured interviews in a randomized sample of 76 hospice cancer patients and caring relatives. During the final eight weeks of the study, patients' awareness showed only slight increase (about 42% fully certain) while relatives' certainty clearly progressed (from 53% to 81% certain). Depression was linked with greater awareness in relatives but not patients. Patients were more anxious if death seemed probable rather than certain or no more than possible. Acceptance usually increased, with 51% of patients and 69% of relatives becoming nearly/fully accepting. Many individuals diverged from the average progress of awareness and acceptance; 18% of patients and 24% of relatives showed fluctuating or falling acceptance.Patients' and relatives' levels of awareness were positively correlated (r = 0.46), as was acceptance (r = 0.47). Relatives accepted more if patients were over 70 years, weak, unable to concentrate or had a quality of life index (QLI) below five, but patients were more accepting if female and if the QLI was above five. Pain did not increase acceptance. Acceptance was described in terms of death's inevitability, faith and spiritual values, life's diminishing rewards, completing life, final benefits, humour, sharing, etc. Individuals often used more than one concept.Generalizing exact figures from this sample needs caution, but some patterns of progress, possible influential factors and ways of acceptance may apply widely.