Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure
Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure
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DOI：
10.1016/j.jpainsymman.2006.12.009
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发表时间：
2007-10-01
影响因子：
4.7
通讯作者：
Sheikh, Aziz
中科院分区：
文献类型：
--
作者：
Murray, Scott A.;Kendall, Marilyn;Sheikh, Aziz
已描述了终末期疾病患者身体衰退的典型轨迹。社会、心理和精神层面的痛苦也可能遵循特征模式。我们试图通过综合两项纵向、定性、深入访谈研究的数据来识别和比较终末期疾病患者在生命最后一年的心理、社会和精神需求的变化，这些研究调查了晚期疾病患者的经历和需求。研究对象为 48 名晚期肺癌 (n = 24) 和心力衰竭 (n = 24) 患者，总共进行了 112 次深度访谈。在个别案例研究中对数据进行分析，然后根据身体疾病的阶段进行横断面分析。典型的社会、心理和精神临终轨迹是显而易见的。在肺癌中，社会轨迹反映了身体衰退，而心理和精神健康在四个关键转变阶段同时下降：诊断、治疗后出院、疾病进展和晚期。在晚期心力衰竭中，社交和心理衰退往往伴随着身体衰退，而精神痛苦则表现出背景波动。全面的临终关怀需要涵盖所有这些方面。了解社会、心理和精神健康的常见模式可能有助于临床医生与患者和护理人员讨论可能的事件进程，并尽量减少疾病进展时的痛苦。
Typical trajectories of physical decline have been described for people with end-stage disease. It is possible that social, psychological, and spiritual levels of distress may also follow characteristic patterns. We sought to identify and compare changes in the psychological, social, and spiritual needs of people with end-stage disease during their last year of life by synthesizing data from two longitudinal, qualitative, in-depth interview studies investigating the experiences and needs of people with advanced illnesses. The subjects were 48 patients with advanced lung cancer (n = 24) and heart failure (n = 24) who gave a total of 112 in-depth interviews. Data were analyzed within individual case studies and then cross-sectionally according to the stage of physical illness. Characteristic social, psychological, and spiritual end-of-life trajectories were discernible. In lung cancer, the social trajectory mirrored physical decline, while psychological and spiritual well-being decreased together at four key transitions: diagnosis, discharge after treatment, disease progression, and the terminal stage. In advanced heartfailure, social and psychological decline both tended to track the physical decline, while spiritual distress exhibited background fluctuations. Holistic end-of-life care needs to encompass all these dimensions. An appreciation of common patterns Of social, psychological, and spiritual well-being may assist clinicians as they discuss the likely course of events with patients and carers and try to minimize distress as the disease progresses.