Characteristics of terminal cancer patients who committed suicide during a home palliative care program
Characteristics of terminal cancer patients who committed suicide during a home palliative care program
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DOI：
10.1016/s0885-3924(01)00295-0
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发表时间：
2001-07-01
影响因子：
4.7
通讯作者：
Tamburini, M
中科院分区：
文献类型：
--
作者：
Filiberti, A;Ripamonti, C;Tamburini, M
癌症患者可能在疾病的任何阶段自杀，文献中已经描述了许多自杀的危险因素。为了确定五名晚期癌症患者在接受训练有素的姑息治疗团队在家护理期间自杀的可能的自杀脆弱因素，通过审查他们的病历进行了心理尸检研究；他们在护理时的症状报告；并通过临时准备的结构化访谈，了解护理人员、医生和护士对事件的回忆。我们收集了有关患者的身体、情感和社会痛苦、他们的性格特征以及他们对疾病和残疾的感受的数据。访谈平均持续两个小时，由康复和姑息治疗部门的社会工作者在自杀事件发生 2 至 8 年后进行。访谈发生在1996年6月至1998年1月之间。所有患者都对缺乏自主性和独立性表现出极大的担忧，拒绝依赖他人，并且害怕/担心失去自主性。 4 名患者出现功能和身体损伤、无法控制的疼痛、意识到自己处于末期以及轻度至中度抑郁症。他们因自己的临床状况而感到绝望，害怕受苦，并感觉成为他人的负担。他们有坚强的性格和管理专业。他们将自己与其他人隔离开来，并且之前曾谈论过自杀。在自杀之前，三名患者对肿瘤治疗产生了不良的身体/情感后果——他们对家人表现出攻击性，一名患者对家庭护理医生表现出攻击性。所有患者同时存在多种脆弱因素。然而;失去自主权和独立性以及害怕失去自主权和独立性以及成为他人的负担是最相关的。识别有自杀风险的癌症患者是尽可能预防这些患者并为其建立适当的社会心理康复的第一步。 J 疼痛症状管理 2991； 22：544-553。 (C) 美国癌症疼痛缓解委员会，2001 年。
Cancer patients may commit suicide at any stage of the disease and many risk factors of suicide have been described in the literature. To identify the possible vulnerability factors of suicide in five terminal cancer patients who committed suicide while they were cared for at home by well-trained palliative care teams, a psychological autopsy study was carried out by reviewing their medical records; their report of symptoms at the time of care; and with the caregivers', doctors', and nurses' recollection of events by means of a structured interview prepared ad hoc. We collected data regarding the physical, emotional, and social suffering of the patients, their personality profile, and their feelings with respect to the illness and disability. The interviews lasted for a mean of two hours and were performed from 2-8 years after the suicide events by the social worker at the Rehabilitation and Palliative Care Division. The interviews took place between June 1996 and January 1998. All the patients showed great concern about the lack of autonomy and independence, refused dependence on others and had fear/worry of losing their autonomy. Four patients presented functional and physical impairments, uncontrolled pain, awareness of being in the terminal stage, and mild to moderate depression. They had a feeling a hopelessness consequent to their clinical conditions, fear of suffering, and feeling of being a burden on others. They had a strong character and managerial professions. They had isolated themselves from others and they had previously talked about suicide. Before committing suicide, three patients had adverse physical/emotional consequences to the oncological treatments-they showed aggressiveness towards their family and one towards the home care physician. Multiple vulnerability factors were present simultaneously in all patients. However; the loss of, and the fear of losing, autonomy and their independence and of being a burden on others were the most relevant. The identification of a cancer patient at risk of committing suicide forms the first step for the prevention of and the setting up of adequate psychosocial rehabilitation of these patients whenever possible. J Pain Symptom Manage 2991; 22:544-553. (C) U.S. Cancer Pain Relief Committee, 2001.