Cohen Marlene Z, Williams Lori, Knight Patti, Snider Julie, Hanzik Kavin, Fisch Michael J
The University of Texas Health Science Center at Houston, School of Nursing, 1100 Holcombe Blvd., Suite 5.533I, Houston, TX 77030, USA.
Support Care Cancer. 2004 Mar;12(3):184-90. doi: 10.1007/s00520-003-0577-y. Epub 2004 Jan 20.
Somatization refers to patients who transform distress and global suffering into pain and symptom expression. We have observed the opposite phenomenon in some outpatients seen for palliative care: patients who transform pain nociception into global suffering or other symptoms. The goal of this study is to describe the meaning of these patients' experiences that are not expressed as pain but seem to masquerade as other symptoms.
Hermeneutic phenomenological research methods guided this study with ten patients with advanced cancer. Interviews continued until data were saturated.
Results included that all patients described frustration that they had outlived their usefulness. All expressed an awareness that they were dying, some very directly with sadness but appreciation for the support they received from family and friends, some with anger, and some who were actively fighting death awareness because they were not "ready" to die. Patients described themselves as strong and healthy and reluctant to take medications, both because this was a new and unacceptable behavior for them, and because they were averse to the side effects.
In conclusion, careful evaluation of symptom experiences can ensure appropriate treatment. Patients with advanced cancer may not report pain even though pain medications often improve their other symptoms and well-being. Patients valued selection of medication that allowed them to remain alert and functional. The meaning of symptoms clearly altered patients' reports and limited treatments they found acceptable. Understanding these meanings is important to ensure that patients are treated in the most appropriate ways possible.
躯体化是指患者将痛苦和整体不适转化为疼痛及症状表现。我们在一些接受姑息治疗的门诊患者中观察到了相反的现象：患者将疼痛感觉转化为整体不适或其他症状。本研究的目的是描述这些患者未表现为疼痛却似乎伪装成其他症状的经历的意义。
本研究采用诠释现象学研究方法，对10例晚期癌症患者进行研究。访谈持续进行直至数据饱和。
结果包括所有患者都描述了自己觉得活着已无用处的挫败感。所有人都表达了自己意识到自己即将死亡，一些人非常直接地带着悲伤，但对家人和朋友给予的支持心怀感激，一些人带着愤怒，还有一些人因为还“没准备好”面对死亡而积极抗拒死亡意识。患者将自己描述为强壮健康且不愿服药，这既是因为这对他们来说是一种新的、不可接受的行为，也是因为他们厌恶药物的副作用。
总之，仔细评估症状体验可确保进行恰当治疗。晚期癌症患者可能不会报告疼痛，尽管止痛药往往能改善他们的其他症状和幸福感。患者重视选择能让他们保持清醒和正常功能的药物。症状的意义明显改变了患者的报告以及他们所能接受的治疗方式。理解这些意义对于确保以最恰当的方式治疗患者很重要。
