Resilience and Coherence in Palliative Medicine

本项目（TP 6）的目的是分析弹性的概念，并与姑息医学领域中其他常用的概念进行比较，如一致性，以尊严为中心的治疗，传记工作，生活质量，生活意义或正念。分析将使用三个阶段。在第一阶段，在医学和社会数据库（如Pubmed， Embase， Psychinfo和b谷歌Scholar）中进行系统的文献研究，将识别有关干预措施（以尊严为中心的治疗，意义治疗，传记，正念减压）和概念（恢复力，连贯感，生命意义）的可用文献，如果与危重患者或垂死患者的医疗护理有关。评价将作为对文献中话语的分析来进行。这将辅以专家访谈。安宁疗护和缓和疗护的相关利害关系人将分六个焦点小组接受访谈，每个小组至少有五名参与者。国际专家将通过电话或skype进行访谈。另外六个焦点小组将与姑息治疗服务的工作人员举行，提供日常实践的观点。在项目的第二阶段，与姑息治疗患者及其护理人员的访谈将用于验证在第一阶段开发的假设。叙述性半结构化访谈将在不同的姑息治疗环境中对30名患者和30名护理人员进行。在第三阶段，这些假设将用于构建一个关于所调查的概念和干预措施之间关系和相关性的扎根理论。假设和扎根理论是项目（TP 6）的结果。此外，还将描述一个矩阵，其中包含了评估的干预措施、概念和价值观的相互影响。这有助于系统地开发医疗和精神评估工具的潜力。然而，作为这个项目的一个特定视角，它还将批判性地讨论评估的边界，以及弹性的哪些方面可能无法被评估工具访问，无论它们是多么优化。因此，该项目还通过扩大和纠正关于潜在不可测量因素的弹性的讨论，为研究小组的第三个目标做出贡献。

The objective of this project (TP 6) is an analysis of the concept of resilience and the comparison with other much used concepts in the field of palliative medicine such as sense of coherence, dignity-centered therapy, biography work, quality of life, meaning in life or mindfulness.The analysis will use three stages. In the first stage a systematic literature research in medical and social data bases such as Pubmed, Embase, Psychinfo and Google Scholar will identify available literature on interventions (dignity-centered therapy, logotherapy, biography, mindfulness stress reduction) and concepts (resilience, sense of coherence, meaning in life), if related to the medical care of severely ill or dying patients. Evaluation will be performed as an analysis of discourse in the literature. This will be supplemented with expert interviews. Relevant stakeholders in hospice and palliaive care will be interviewed in six focus groups with at least five participants. International experts will be interviewed via telephone or skype. Another six focus groups will be held with staff members of palliative care services, providing the perspective of daily routine practice. In the second stage of the project interviews with palliative care patients and their caregivers will be used to validate the hypotheses that have been developed in the first stage. Narrative semistructured interviews will be performed with 30 patients and 30 caregivers in different palliative care settings. In the third phase the hypotheses will be used for the construction of a grounded theory on the relationship and correlations between the concepts and interventions under investigation. The hypotheses and the grounded theory are the results of the project (TP 6). In addition, a matrix with the mutual influences of the evaluated interventions, concepts and values will be described. This contributes to the systematic development of the potential for medical and spiritual assessment instruments. However, as a specific perspective of this project it will also discuss critically the bounderies of assessment, and which aspects of resilience may not be accessible to assessment instruments, no matter how optimal they are constructed. The project thus also contributes to the third objective of the research group by expanding and correcting the discussion on resilience with potential unmeasurable elements.