Conceptualization of psycho-existential suffering by the Japanese Task Force: The first step of a nationwide project
Conceptualization of psycho-existential suffering by the Japanese Task Force: The first step of a nationwide project
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日本工作组对心理存在痛苦的概念化：全国项目的第一步
DOI：
10.1017/s1478951506060354
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发表时间：
2006
影响因子：
2.2
通讯作者：
T. Morita
中科院分区：
文献类型：
--
作者：
Hisayuki Murata;T. Morita
背景和目的：尽管缓解心理存在或精神痛苦是姑息治疗临床医生最重要的作用之一，但缺乏公认的概念框架导致该领域的研究相当混乱。本文的主要目的是说明日本工作组制定概念框架的过程，作为全国项目的第一步。方法：我们采用了与 26 名小组成员和 100 名多学科同行评审员建立共识的方法。该小组由六名姑息治疗医生、六名精神病学家、五名护理专家、四名社会工作者或心理学家、两名哲学家、一名牧师护理工作者、一名社会学家和一名职业治疗师组成。通过两天的面对面讨论和电子邮件后续讨论，我们达成了共识。结果：小组同意采用概念框架作为本研究的起点，结合多中心观察的经验模型、理论假设和日本的良好死亡研究。我们将“心理存在的痛苦”定义为“因存在和自我意义的消失而引起的痛苦”。我们假设心理存在的痛苦是由构成人类存在和意义的基本组成部分的丧失引起的：失去关系（与他人）、失去自主性（独立、对未来的控制、自我的连续性）和失去暂时性（未来）。意义感和内心的平静可以被解释为心理存在状态的结果，因此也是我们干预的一般终点。该模型提取了未来需要深入研究的七个类别：关系、控制、自我的连续性、对他人的负担、生成性、死亡焦虑和希望。结论：日本全国多学科小组商定了一个概念框架，以促进对绝症癌症患者的心理存在痛苦的研究。该模型将根据持续的定性研究、调查和干预试验进行修订。
Background and purpose: Although the relief of psycho-existential or spiritual suffering is one of the most important roles of palliative care clinicians, lack of an accepted conceptual framework leads to considerable confusion in research in this field. The primary aim of this article is to illustrate the process of developing a conceptual framework by the Japanese Task Force as the initial step of a nationwide project. Methods: We used consensus-building methods with 26 panel members and 100 multidisciplinary peer reviewers. The panel consisted of six palliative care physicians, six psychiatrists, five nursing experts, four social workers or psychologists, two philosophers, a pastoral care worker, a sociologist, and an occupational therapist. Through 2 days of face-to-face discussion and follow-up discussion by e-mail, we reached a consensus. Results: The group agreed to adopt a conceptual framework as the starting point of this study, by combining the empirical model from multicenter observations, a theoretical hypothesis, and good death studies in Japan. We defined “psycho-existential suffering” as “pain caused by extinction of the being and the meaning of the self.” We assumed that psycho-existential suffering is caused by the loss of essential components that compose the being and the meaning of human beings: loss of relationships (with others), loss of autonomy (independence, control over future, continuity of self), and loss of temporality (the future). Sense of meaning and peace of mind can be interpreted as an outcome of the psycho-existential state and thus the general end points of our interventions. This model extracted seven categories to be intensively studied in the future: relationship, control, continuity of self, burden to others, generativity, death anxiety, and hope. Conclusions: A Japanese nationwide multidisciplinary group agreed on a conceptual framework to facilitate research in psycho-existential suffering in terminally ill cancer patients. This model will be revised according to continuing qualitative studies, surveys, and intervention trials.