Leong Ian Yi-Onn, Lee Angel Onn-Kei, Ng Tzer Wee, Lee Lay Beng, Koh Nien Yue, Yap Eliada, Guay Sarah, Ng Lee Min
Palliative Care Service and Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
Palliat Med. 2004 Jan;18(1):12-8. doi: 10.1191/0269216304pm859oa.
To determine, using the perspective of a hospital-based palliative care service (PCS), the spiritual and psychosocial impact of a novel and potentially fatal viral epidemic on patients, their families and health care workers.
Qualitative study using semi-structured interviews. The data were analysed using the constant comparative method and were validated using respondent validation.
Eight palliative care workers.
Tan Tock Seng Hospital (TTSH), the hospital designated to manage all cases of Severe Acute Respiratory Syndrome (SARS) in Singapore.
Disease containment resulted in isolation, where isolation meant the disruption of connectedness. This disruption of connectedness took place at multiple levels: in the patient himself, between the patient and the family, within the family, between the patient and the health care worker, between the patient and society, and between health care workers. As the nature of the disease was uncertain, prognostication was inaccurate. This created difficulties in helping patients and their families prepare for death. The fear of facing the unknown led to safety-seeking behaviours, which could be overcome by repeated exposure to the feared situation. The process of bereavement was disturbed, as traditional death rituals could not be performed by the family. Informants perceived themselves to be suffering as they suffered the same anxieties, fears and grief as the patient.
Dealing with a novel viral epidemic creates spiritual and psychosocial issues similar to those encountered in a palliative care practice. Palliative care workers would do well to be aware of such issues and act proactively when such epidemics arise.
从一家医院姑息治疗服务（PCS）的角度，确定一种新型且可能致命的病毒性流行病对患者、其家人及医护人员的精神和心理社会影响。
采用半结构式访谈的定性研究。数据采用持续比较法进行分析，并通过受访者验证进行验证。
八名姑息治疗工作者。
新加坡负责管理所有严重急性呼吸综合征（SARS）病例的丹戎巴葛医院（TTSH）。
疾病控制导致隔离，而隔离意味着联系的中断。这种联系的中断发生在多个层面：在患者自身、患者与家人之间、家庭内部、患者与医护人员之间、患者与社会之间以及医护人员之间。由于疾病的性质不确定，预后判断不准确。这给帮助患者及其家人为死亡做准备带来了困难。对面对未知的恐惧导致了寻求安全的行为，而反复接触恐惧情境可以克服这种行为。丧亲过程受到干扰，因为家人无法进行传统的死亡仪式。受访者认为自己也在受苦，因为他们与患者有着相同的焦虑、恐惧和悲伤。
应对新型病毒性流行病会产生与姑息治疗实践中遇到的类似的精神和心理社会问题。姑息治疗工作者应意识到此类问题，并在出现此类流行病时积极采取行动。
