SELF-CARE IN SYMPTOM MANAGEMENT AT THE END OF LIFE

近年来，越来越多的人注意到， 病人的临终关怀，包括一些国家倡议， 这个结局在与临终关怀相关的许多问题中， 关注的焦点，症状管理可能收到了最大的金额 由于控制不充分的症状会增加患者的痛苦， 患者及其家属。人们还普遍认识到， 令人忧虑的病征对病人的生活质素构成威胁。 然而，有趣的是，绝大多数关于临终症状的研究 管理层专注于临床管理。虽然收容所， 护士服务参与和专业团体（如美国大学 医生）强调了准备病人和他们的重要性。 非正式护理人员识别和科普症状，并认识到 需要专业干预，在生命结束时研究非常不足 研究是病人和他们的照顾者如何评估症状和 他们用来管理它们的自我护理策略。然而，随着医学的进步 许多疾病的最后阶段和护理更有可能在 在门诊基础上，患者可能会越来越多地尝试管理许多 他们的症状本身，或者作为临床管理的辅助手段， 战略或代替它，当他们认为临床护理的好处， 抵消了它的成本。在生命结束时的自我照顾也可能是出于以下动机： 例如，患者希望保留对他们的护理、疾病 和生活此外，往往存在于治疗结束时的护理分散化， 生活，许多症状的临床管理不足，以及经常注意到的 当治愈是长期目标时，医生倾向于从患者身上撤出， 可能有助于患者感到需要和希望 自我管理他们的症状。拟议的研究将调查症状 80名老年癌症患者（55岁以上）的过程和自我护理行为， 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） 所采用的自我护理活动的种类; 4）对常见的情绪反应 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.