Professionally perceived effectiveness of psychosocial interventions for existential suffering of terminally ill cancer patients
Professionally perceived effectiveness of psychosocial interventions for existential suffering of terminally ill cancer patients
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DOI：
10.1191/0269216303pm825oa
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发表时间：
2003-01-01
影响因子：
4.4
通讯作者：
Kashiwagi, T
中科院分区：
文献类型：
--
作者：
Hirai, K;Morita, T;Kashiwagi, T
背景：虽然对存在痛苦的综合护理是姑息治疗的重要组成部分，但专业人士对其概念和功效知之甚少。进行问卷调查的目的是：1）探索专家推荐的心理社会干预措施的基本结构，2）确定每种干预措施对特定存在困扰的专业认知有效性，3）检查专业对其建议的影响。方法：向 701 名日本精神科医生、118 名心理学家和 372 名姑息治疗护士邮寄了一份问卷，其中包含三种情况，代表患有不确定性相关焦虑、内疚感和依赖性相关无意义的绝症癌症患者。结果：共收到 456 份回复（回复率 = 38%）。推荐的心理社会干预措施分为六个子类别：“支持表达方法”、“提供舒适的环境”、“以意义为中心的方法”、“存在”、“教育和应对技能培训”和“宗教方法”。所有小插图都一致推荐“支持表达方法”。另一方面，对于不确定性相关焦虑的患者，最推荐“提供舒适的环境”，对于感到依赖相关的无意义的患者，最推荐“以意义为中心的方法”和“存在”。精神科医生对精神药物治疗的有效性的评估显着高于心理学家和护士，而护士对所有其他干预措施的有效性的评估显着高于精神科医生和心理学家。结论：专家评估了各种临床干预措施在缓解存在痛苦方面是否有效，尽管每种干预措施的感知效果水平根据痛苦的性质及其特殊性而有所不同。为了有效减轻癌症晚期患者的生存痛苦，需要跨学科团队的综合护理。
Background: Although integrated care for existential suffering is an essential part of palliative care, little is known about its concept and efficacy as perceived by professionals. A questionnaire survey was carried out to 1) explore the underlying structure of psychosocial interventions recommended by specialists, 2) identify the professionally perceived effectiveness of each intervention for specific existential distress, and 3) examine the effects of specialty on their recommendations. Methods: A questionnaire with three scenarios representing terminally ill cancer patients with uncertainty-related anxiety, guilt feelings, and dependency-related meaninglessness was mailed to 701 Japanese psychiatrists, 118 psychologists, and 372 palliative care nurses. Results: A total of 456 responses were obtained ( response rate = 38%). Recommended psychosocial interventions were classified into six subcategories: 'a supportive-expressive approach,' 'providing comfortable environments,' 'meaning-centered approach,' 'being, ' education and coping skills training,' and 'a religious approach.'A' supportive-expressive approach' was consistently recommended in all vignettes. On the other hand, ' providing comfortable environments' was most recommended for patients with uncertainty-related anxiety, and a 'meaning-centered approach' and 'being` were most recommended for patients feeling dependency-related meaninglessness. Psychiatrists estimated the effectiveness of psychopharmacological treatment significantly higher than psychologists and nurses, while nurses evaluated efficacy of all other interventions significantly higher than psychiatrists and psychologists. Conclusions: Experts evaluated a variety of clinical interventions as effective in palliating existential suffering, although the perceived levels of efficacy of each intervention differed according to the nature of suffering and their specialties. To effectively alleviate existential suffering in terminally ill cancer patients, an integrated care by an interdisciplinary team is necessary.