SELF-CARE IN SYMPTOM MANAGEMENT AT THE END OF LIFE

近年来，人们越来越多地关注加强 病人的临终关怀，包括一些国家倡议，以实现 这一头。在与临终关怀有关的许多问题中， 感兴趣的焦点，症状管理可能收到了最多的 令人担忧，因为没有充分控制的症状增加了 无论是病人还是他们的家属。人们还广泛认识到 令人痛苦的症状对患者的生活质量构成了威胁。 然而，有趣的是，绝大多数关于临终症状的研究 管理层一直把重点放在临床管理上。在临终关怀期间，来访的人 护士服务和专业团体(例如，美国护士学院 医生)强调了准备病人和他们的医生的重要性 非正式照顾者，以识别和处理症状并识别何时 专业干预表明，在生命末期非常缺乏研究 研究是患者和他们的照顾者如何评估症状和 他们使用自我照顾策略来管理自己。然而，随着医学进步的深入 许多疾病和护理的最后阶段更有可能在 在门诊的基础上，患者可能会越来越多地尝试管理许多 他们的症状可以作为临床治疗的辅助手段 当他们意识到临床护理的好处时，策略或取而代之 被它的成本所抵消。在生命的末期自我照顾也可能会被激励 例如，由于患者希望对自己的护理、疾病保持一定的控制权 和生命。此外，保健的碎片化往往存在于 生活，对许多症状的临床处理不充分，以及经常注意的 当治愈的目标更长时，医生倾向于退出患者， 可能会导致患者感到有必要并渴望 自我管理他们的症状。拟议的研究将对症状进行调查 80例老年癌症患者(年龄55岁以上)的病程及自理行为 晚期疾病及其照顾者(n=60)。具体来说，我们将调查： 1)症状评估过程；2)对常见症状的应对反应：3) 所采用的自我照顾活动的种类；4)对共同的情绪反应 症状。

In recent years, there has been growing attention to enhancing patients' end of life care, including a number of national initiatives toward this end. Of the many issues related to end of life care hat have been the focus of interest, symptom management has perhaps received the greatest amount of concern because inadequately controlled symptoms add to the suffering of both patients and their family members. It is also widely recognized that distressing symptoms pose a threat to the patients' quality of life. Interestingly, however, the vast majority of research on end of life symptom management has focused on its clinical management. While hospices, the Visiting Nurse Service engage and professional groups (e.g. American College of Physicians) have stressed the importance of preparing patients and their informal caregivers to identify and cope with symptoms and to recognize when professional intervention is indicated, very understudied in end of life research is how patients and their caregiver appraise symptoms and the self-care strategies they use to manage them. Yet, as medical advances extend the final stages of many illnesses and care is more likely to be delivered on an outpatient basis, patients are likely to increasingly try to manage many of their symptoms on their own either as an adjunct to clinical management strategies or in lieu of it, when they perceive the benefits of clinical care as offset by its costs. Self care at the end of life may also be motivated for example, by patients' desire to retain some control over their care, illness and life. Further, the fragmentation of care that often exists at the end of life, the inadequate clinical management of many symptoms, and the often noted tendency for physicians to withdraw from patients when cure is longer the goal, may contribute to the likelihood that patients will feel the need and desire to self mange their symptoms. The proposed study will investigate the symptom process and self-care behaviors of 80 older cancer (age 55+) patients with advanced disease and their caregivers (n=60). Specifically we will investigate: 1) the symptom appraisal process; 2) coping responses to common symptoms: 3) the kinds of self-care activities employed; 4) emotional responses to common symptoms.