Wilson Candice T, Fletcher Paula C
Department of Kinesiology and Physical Education, Wilfred Laurier University, Waterloo, Ontario, Canada.
Clin Nurse Spec. 2002 Nov;16(6):298-305. doi: 10.1097/00002800-200211000-00013.
Although death is inevitable, it continues to remain a taboo issue for society. A failure to discuss the unavoidable may represent a safeguard to avoid dealing with mortality and related fears. Many patients who are terminally ill spend their days feeling alone, misunderstood, and afraid. Kubler-Ross attempted to strip death of its negative connotations and to provide a venue for the terminally ill to have a voice. Using information from more than 200 clinical interviews, Kubler-Ross revealed a trend in emotions over time in most, but not all, of her patients, which enabled her to formulate a model of coping with death that included 5 interdependent emotional stages: denial, anger, bargaining, depression, and acceptance. This model has become the most widely accepted and popularized model on death and dying, often cited as the Five Stages of Grief." However, given the lack of research concerning Kubler-Ross's model, completing work in this area seems warranted. The purpose of this case study was to examine one individual's emotional journey after being diagnosed with terminal colon cancer. More specifically, the goals were twofold: (1) to provide the participant with a voice and to allow her story to be told by examining the major external events (ie,surgery, chemotherapy) occurring since the diagnosis that affected her emotional and physical well-being and (2) to determine whether the participant's emotional journey paralleled Kubler-Ross's model, to what extent, and whether new emotions or stages occurred. The participant, a 50-year-old female, was diagnosed with stage 4 Duke Stage D colon cancer. Qualitative information was collected in face-to-face interviews, newspaper articles about the participant, and e-mail correspondence (as form letters to a group of friends and supporters) and subsequently analyzed for trends. The overall results revealed clear existence of the 5 stages of grief as outlined in the Kubler-Ross model. Analyses also revealed that the stages often overlapped or occurred simultaneously. Additionally, the participant regressed to earlier stages when subjected to negative external factors. Four other highly salient emotions were also prevalent throughout the participant's experience with colon cancer, namely joy, fear, hope, and numbness. The findings from this case study help to validate Kubler-Ross's stages. Further, the importance of the voice of the participant cannot be overemphasized. This case study clearly depicts the unique thoughts and emotions during one woman's struggle with colon cancer, sentiments that are often overlooked in quantitative analysis.
尽管死亡不可避免,但它仍是社会的一个禁忌话题。未能讨论这一不可避免之事可能是一种避免面对死亡及相关恐惧的自我保护。许多绝症患者整日感到孤独、被误解和恐惧。库伯勒 - 罗斯试图消除死亡的负面含义,并为绝症患者提供一个发声的场所。通过200多次临床访谈收集的信息,库伯勒 - 罗斯揭示了大多数(但并非所有)患者随时间推移的情绪变化趋势,这使她能够构建一个应对死亡的模型,其中包括五个相互依存的情绪阶段:否认、愤怒、讨价还价、抑郁和接受。这个模型已成为关于死亡和临终最广泛接受和普及的模型,常被称为“悲伤五阶段”。然而,鉴于对库伯勒 - 罗斯模型的研究不足,在这一领域开展相关工作似乎很有必要。本案例研究的目的是考察一名被诊断为晚期结肠癌患者的情感历程。更具体地说,目标有两个:(1)通过审视自诊断以来发生的影响其情感和身体健康的主要外部事件(即手术、化疗),为参与者提供发声机会并讲述她的故事;(2)确定参与者的情感历程是否与库伯勒 - 罗斯模型相符、相符程度如何,以及是否出现了新的情绪或阶段。参与者是一名50岁女性,被诊断为杜克D期4期结肠癌。通过面对面访谈、关于该参与者的报纸文章以及电子邮件通信(作为发给一群朋友和支持者的格式信件)收集定性信息,随后对其进行趋势分析。总体结果显示,库伯勒 - 罗斯模型中概述的悲伤五阶段明显存在。分析还表明,这些阶段常常重叠或同时出现。此外,当受到负面外部因素影响时,参与者会倒退到早期阶段。在该参与者患结肠癌的整个经历中,还有其他四种非常突出的情绪也很普遍,即喜悦、恐惧、希望和麻木。本案例研究的结果有助于验证库伯勒 - 罗斯的阶段理论。此外,参与者声音的重要性再怎么强调也不为过。本案例研究清晰地描绘了一名女性与结肠癌抗争期间独特的思想和情感,而这些情感在定量分析中常常被忽视。