Dyadic Model of Adaptation to Life-Limiting Illness
Dyadic Model of Adaptation to Life-Limiting Illness
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DOI：
10.1089/jpm.2019.0444
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发表时间：
2020-02-28
影响因子：
2.8
通讯作者：
Knight, Sara J.
中科院分区：
文献类型：
--
作者：
Ahluwalia, Sangeeta;Reddy, Neha K.;Knight, Sara J.
背景：我们之前开发了重新融入社会模型来描述个人在生命结束时的调整过程。然而，照顾者和亲人也需要大量的支持，必须努力重新想象他们彼此之间的关系。目的：我们试图建立一个二元的重新融合模型，描述在患者和另一个重要的人之间发生的调整过程的关键部分，而不是作为两个独立的个体。方法：我们改进了这个二元过程的初步概念模型，并从配偶二元相互关系的叙述文献综述中得到了结果。我们评估了文献中关于二元调整的新兴主题，以确定它们是否符合我们最初的重返社会模型，并通过共识讨论，将研究结果应用于最终提出的生命末期二元重返社会的概念模型。结果：文献中二元调整的例子涉及原始融合模型中描述的理解、创造性适应和融合过程。证据还支持了新二元模型中三个实质性的补充：(1)对二元组合的和谐被打断的共同理解；(2)考虑“我们”（二人组）和“我”（个体）在相互反思中创造共享叙事；(3)强调关系是影响调整过程的因素。结论：现有证据支持该模型中二联体成员在理解、创造性适应和重新融入这三个适应过程中的相互依赖关系。这种二元融合模式在临床实践中可用于支持面临生命限制疾病的二元。
Context: We previously developed the reintegration model to describe the adjustment process for individuals at the end of life. However, caregivers and loved ones also require significant support and must work to reimagine their relationship with one another.Objectives: We sought to develop a dyadic version of the reintegration model that delineates key parts of the adjustment process that occur between the patient and another significant person rather than as two separate individuals.Methods: We refined an initial conceptual model of this dyadic process with findings from a narrative literature review on spousal dyadic mutuality. We assessed emergent themes regarding dyadic adjustment from the literature for their fit with our original reintegration model and through consensus discussion, applied the findings to a final proposed conceptual model of dyadic reintegration at the end of life.Results: Examples of dyadic adjustment in the literature relate to the comprehension, creative adaptation, and reintegration processes described in the original reintegration model. Evidence also supported three substantive additions in the new dyadic model: (1) shared understanding that the harmony of the dyad is interrupted; (2) consideration of the "we" (the dyad) and the "I" (the individual) in mutual reflection to create a shared narrative; and (3) emphasis on relationship as a factor impacting adjustment processes.Conclusions: Available evidence supports interdependent relationships between members of dyads for the three adaptation processes of comprehension, creative adaptation, and reintegration in the model. This dyadic reintegration model can be useful in clinical practice to support dyads facing life-limiting illness.