Chochinov H M, Tataryn D J, Wilson K G, Ennis M, Lander S
Department of Psychiatry, University of Manitoba, Winnipeg, Canada.
Psychosomatics. 2000 Nov-Dec;41(6):500-4. doi: 10.1176/appi.psy.41.6.500.
The authors rated patients who were in advanced stages of cancer and in their final few weeks of life on their level of awareness of their medical prognosis (N = 200, mean age = 71.0 years). The authors measured prognostic awareness with a semistructured interview, dividing patients into those acknowledging No Awareness, Partial Awareness, and Complete Awareness. The authors also administered a semistructured interview for depressive disorders, along with an assessment of various demographic and social support measures. Nineteen patients (9.5%) denied awareness of both their terminal prognosis and foreshortened life expectancy. Thirty-four patients (17%) were placed in the partial awareness category, with the remaining 147 patients (73.5%) reporting complete awareness. Depression was nearly three times greater among patients who did not acknowledge their prognosis, as compared with those who demonstrated partial or complete acknowledgment (chi2 = 7.094), P = 0.029). In addition to depression, male patients, older patients, and those having "intense social contact" were associated with lower ratings of prognostic awareness. Dying patients differ in respect to their capacity to acknowledge their prognosis. Prognostic disavowal is most likely to arise in patients with underlying psychological distress and emotional turmoil.
作者对处于癌症晚期、生命仅剩最后几周的患者的医疗预后知晓水平进行了评估（N = 200，平均年龄 = 71.0岁）。作者通过半结构化访谈来测量预后知晓情况，将患者分为无知晓、部分知晓和完全知晓三类。作者还进行了关于抑郁症的半结构化访谈，并评估了各种人口统计学和社会支持指标。19名患者（9.5%）否认知晓自己的终末期预后和预期寿命缩短情况。34名患者（17%）被归为部分知晓类别，其余147名患者（73.5%）报告完全知晓。与部分或完全承认预后的患者相比，不承认自己预后的患者患抑郁症的几率几乎高出三倍（卡方 = 7.094，P = 0.029）。除了抑郁症外，男性患者、老年患者以及那些“有密切社会交往”的患者的预后知晓评分较低。临终患者在承认自己预后的能力方面存在差异。预后否认最有可能出现在有潜在心理困扰和情绪动荡的患者中。
