癌症姑息治疗中的尊严系列研究

doi:10.3969/j.issn.1674-490X.2019.02.010

摘要/Abstract

摘要： 维护患者尊严是癌症姑息治疗的基本原则之一。针对晚期癌症患者的尊严系列研究进行综述,介绍晚期癌症患者尊严的概念及其影响因素;结合国外晚期癌症患者尊严受损情况,着重介绍中国癌症患者尊严受损水平及其影响因素;概述尊严理论模型;简述基于尊严理论模型开发的两种尊严心理干预,即尊严疗法和尊严谈话;简介通过应用扎根理论开发的安宁疗护尊严管理模型和尊严维护照护之ABCD模型。以指导医务人员在临床实践中维护患者的尊严。

关键词: 癌症, 姑息治疗, 尊严, 尊严相关痛苦, 尊严模型, 尊严疗法, 尊严谈话, 尊严维护照护

Abstract: Maintaining the dignity of patients is a basic tenet of palliative care. A series of studies on dignity in palliative care were synthesized in this paper. The concept of dying with dignity and its influencing factors were summarized; levels of loss of dignity in Chinese patients with cancer and the predictive factors were reported; the model of dignity in terminally ill was introduced; the developments of two dignity psychotherapeutic interventions, dignity therapy and dignity talk, based on the model of dignity, were introduced; and finally, the preliminary model of dignity management in hospice and the A, B, C, and D of dignity conserving care were introduced, aiming to guide healthcare providers to provide dignity conserving care in palliative care clinical practice.

Key words: cancer, palliative care, dignity, dignity-related distress, dignity model, dignity therapy, dignity talk, dignity conserving care

中图分类号:

陈芷谦,郭巧红. 癌症姑息治疗中的尊严系列研究[J]. 医学研究与教育, 2019, 36(2): 54-61.

参考文献

[1] STEWART B W, WILD C P. World Cancer Report 2014[R]. Lyon, France: International Agency for Research on Cancer, 2014.
[2] CHEN W, ZHENG R, ZHANG S, et al. Cancer incidence and mortality in China in 2013: an analysis based on urbanization level[J]. Chin J Cancer Res, 2017, 29(1): 1-10. DOI: 10.21147/j.issn.1000-9604.2017.01.01.
[3] LIN Y P, WATSON R, TSAI Y F. Dignity in care in the clinical setting: a narrative review[J]. Nurs Ethics, 2013, 20(2): 168-177. DOI: 10.1177/0969733012458609.
[4] GUO Q, JACELON C S. An integrative review of dignity in end-of-life care[J]. Palliat Med, 2014, 28(7): 931-940. DOI: 10.1177/0269216314528399.
[5] POKORNY M. The effect of nursing care on human dignity in the critically ill adult[D]. Charlottesville:University of Virginia, 1989.
[6] KOPFENSTEINER T R. Death with dignity: a roman catholic perspective[J]. Linacre Q, 1996, 63(4):64-75.
[7] TURNER K, CHYE R, AGGARWAL G, et al. Dignity in dying: a preliminary study of patients in the last three days of life[J]. J Palliat Care, 1996, 12(2):7-13.
[8] ENES S P. An exploration of dignity in palliative care[J]. Palliat Med, 2003, 17(3):263-269. DOI: 10.1191/0269216303pm699oa.
[9] STREET A F, KISSANE D W. Constructions of dignity in end-of-life care[J]. J Palliat Care, 2001, 17(2):93-101.
[10] ALLMARK P. Death with dignity[J]. J Med Ethics, 2002, 28(4):255-257.
[11] CHOCHINOV H M. Dignity-conserving care—a new model for palliative care: helping the patient feel valued[J]. JAMA, 2002, 287(17):2253-2260.
[12] CHOCHINOV H M, HACK T, HASSARD T, et al. Dignity in the terminally ill: a cross-sectional, cohort study[J]. Lancet, 2002, 360(9350):2026-2030.
[13] CHOCHINOV H M, HACK T, MCCLEMENT S, et al. Dignity in the terminally ill: a developing empirical model[J]. Soc Sci Med, 2002, 54(3):433-443.
[14] MCDONALD M. Dignity at the end of our days: personal, familial, and cultural location[J]. J Palliat Care, 2004, 20(3):163-170.
[15] PULLMAN D. Death, dignity, and moral nonsense[J]. J Palliat Care, 2004, 20(3):171-178.
[16] DOORENBOS A Z, WILSON S A, COENEN A. A cross-cultural analysis of dignified dying[J]. J Nurs Scholarsh, 2006, 38(4):352-357.
[17] KARLSSON M, MILBERG A, STRANG P. Dying with dignity according to Swedish medical students[J]. Supportive Care in Cancer, 2006, 14(4):334-339. DOI: 10.1007/s00520-005-0893-5.
[18] WILSON S A, COENEN A, DOORENBOS A. Dignified dying as a nursing phenomenon in the United States[J]. J Hospice Palliat Nurs, 2006, 8(1):34-41.
[19] ASHURST A. Palliative care: maintaining dignity[J]. Nurs Residential Care, 2013, 9(1):22-24.
[20] LEUNG D. Granting death with dignity: patient, family and professional prespectives[J]. Int J Palliat Nurs, 2007, 13(4):170-174. DOI: 10.12968/ijpn.2007.13.4.23487.
[21] PLESCHBERGER S. Dignity and the challenge of dying in nursing homes: the residents' view[J]. Age Ageing, 2007, 36(2):197-202. DOI: 10.1093/ageing/afl152.
[22] VOLKER D L,LIMELICK M. What constitutes a dignified death? The voice of oncology advanced practice nurses[J]. Clin Nurse Spec, 2007, 21(5):241-247.
[23] DWYER L L, ANDERSHED B, NORDENFELT L, et al. Dignity as experienced by nursing home staff[J]. Int J Older People Nurs, 2010, 4(3):185-193. DOI: 10.1111/j.1748-3743.2008.00153.x.
[24] HALL S, LONGHURST S, HIGGINSON I. Living and dying with dignity: a qualitative study of the views of older people in nursing homes[J]. Age Ageing, 2009,38(4):411-416. DOI: 10.1093/ageing/afp069.
[25] PERIYAKOIL V S, KRAEMER H C, NODA A. Creation and the empirical validation of the dignity card-sort tool to assess factors influencing erosion of dignity at life's end[J]. J Palliat Med, 2009, 12(12):1125-1130. DOI: 10.1089/jpm.2009.0123.
[26] TAIT G R, HODGES B D. End-of-life care education for psychiatric residents: attitudes, preparedness, and conceptualizations of dignity[J]. Academic Psychiatry, 2009, 33(6):451-456. DOI: 10.1176/appi.ap.33.6.451.
[27] PERIYAKOIL V S, NODA A M, KRAEMER H C. Assessment of factors influencing preservation of dignity at life's end: creation and the cross-cultural validation of the preservation of dignity card-sort tool[J]. J Palliat Med, 2010, 13(5):495-500. DOI: 10.1089/jpm.2009.0279.
[28] ALBERS G, PASMAN H R, RURUP M L, et al. Analysis of the construct of dignity and content validity of the patient dignity inventory[J]. Health Qual Life Outcomes, 2011, 9:45. DOI: 10.1186/1477-7525-9-45.
[29] KARLSSON C, BERGGREN I. Dignified end-of-life care in the patients' own homes[J]. Nurs Ethics, 2011, 18(3):374-385. DOI: 10.1177/0969733011398100.
[30] POLES K, BOUSSO R S. Dignified death: Concept development involving nurses and doctors in pediatric intensive care units[J]. Nurs Ethics, 2011, 18(5):694-709. DOI: 10.1177/0969733011408043.
[31] ANTIEL R M, CURLIN F A, JAMES K M, et al. Dignity in end-of-life care: results of a national survey of U.S. physicians[J]. J Pain Symptom Manag, 2012, 44(3):331-339. DOI: 10.1016/j.jpainsymman.2011.09.020.
[32] VOSIT-STELLER J, WHITE P, BARRON A M, et al. Enhancing end-of-life care with dignity: characterizing hospice nursing in Romania[J]. Int J Palliat Nurs, 2010, 16(9):459-464. DOI: 10.12968/ijpn.2010.16.9.78645.
[33] BROWN H, JOHNSTON B, OSTLUND U. Identifying care actions to conserve dignity in end-of-life care[J]. Br J Community Nurs, 2011, 16(5):238-245. DOI: 10.12968/bjcn.2011.16.5.238.
[34] QUINT J C. The threat of death: some consequences for patients and nurses[J]. Nurs Forum, 1969, 8(3):286-300.
[35] CHOCHINOV H M, KRISJANSON L J, HACK T F, et al. Dignity in the terminally ill: revisited[J]. J Palliat Med, 2006, 9(3):666-672. DOI: 10.1089/jpm.2006.9.666.
[36] HACK T F, CHOCHINOV H M, HASSARD T, et al. Defining dignity in terminally ill cancer patients: a factor-analytic approach[J]. Psychooncology, 2010, 13(10):700-708. DOI: 10.1002/pon.786.
[37] VLUG M G, DE VET H C, PASMAN H R, et al. The development of an instrument to measure factors that influence self-perceived dignity[J]. J Palliat Med, 2011, 14(5):578-586. DOI: 10.1089/jpm.2010.0513.
[38] JOHNSTON B, STLUND U,BROWN H. Evaluation of the dignity care pathway for community nurses caring for people at the end of life[J]. Int J Palliat Nurs,2012, 18(10):483-489. DOI: 10.12968/ijpn.2012.18.10.483.
[39] OHLÉN J. Violation of dignity in care-related situations[J]. Res Theory Nurs Prac, 2004, 18(4):371-385.
[40] 魏亚红. 中晚期癌症患者的尊严受损水平及其影响因素的研究[D]. 石家庄:河北医科大学,2017.
[41] OECHSLE K, WAIS M C, VEHLING S, et al. Relationship between symptom burden, distress, and sense of dignity in terminally ill cancer patients[J]. J Pain Symptom Manag, 2014, 48(3): 313-321. DOI: 10.1016/j.jpainsymman.2013.10.022.
[42] 郭巧红.尊严疗法在安宁疗护实践中的应用[J]. 中国护理管理, 2018, 18(3): 316-319. DOI: 10.3969/j.issn.1672-1756.2018.03.007.
[43] JOHNSTON B, LARKIN P, CONNOLLY M, et al. Dignity-conserving care in palliative care settings: an integrative review[J]. J Clin Nurs, 2015, 24(13-14):1743-1772. DOI: 10.1111/jocn.12791.
[44] HO A H, CHAN C L, LEUNG P P, et al. Living and dying with dignity in Chinese society: perspectives of older palliative care patients in Hong Kong[J]. Age Ageing, 2013, 42(4): 455-461. DOI: 10.1093/ageing/aft003.
[45] LI H C, RICHARDSON A, SPECK P, et al. Conceptualisations of dignity at the end of life: exploring theoretical and cultural congruence with dignity therapy[J]. J Adv Nurs, 2014, 70(12): 2920-2931. DOI: 10.1111/jan.12455.
[46] CHOCHINOV H M,HACK T, HASSARD T, et a1. Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life[J]. J Clin Oncol, 2005, 23(24): 5520-5525. DOI: 10.1200/JCO.2005.08.391.
[47] FITCHETT G, EMANUEL L, HANDZO G, et al. Care of the human spirit and the role of dignity therapy: a systematic review of dignity therapy research[J]. BMC Palliat Care, 2015, 14:8. DOI: 10.1186/s12904-015-0007-1.
[48] MARTÍNEZ M, ARANTZAMENDI M,BELAR A, et al. “Dignity therapy”, a promising intervention in palliative care: a comprehensive systematic literature review[J]. Palliat Med, 2017, 31(6):492-509. DOI: 10.1177/0269216316665562.
[49] FERRELL B R, TEMEL J S, TEMIN S, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update[J]. J Clin Oncol, 2017, 35(1): 96-112. DOI: 10.1200/JCO.2016.70.1474.
[50] GUO Q, CHOCHINOV H M, MCCLEMENT S, et al. Development and evaluation of the dignity talk question framework for palliative patients and their families: a mixed methods study[J]. Palliat Med,2018, 32(1): 195-205. DOI: 10.1177/0269216317734696.
[51] GUO Q. A preliminary model of dignity management in hospice[D]. Amherst: University of Massachusetts Amherst, 2014.
[52] CHOCHINOV H M. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care[J]. BMJ, 2007, 335(7612): 184-187. DOI: 10.1136/bmj.39244.650926.47.