Coyle Nessa
Pain and Palliative Care Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
J Pain Symptom Manage. 2004 Apr;27(4):300-9. doi: 10.1016/j.jpainsymman.2003.08.008.
Seven individuals living with advanced cancer, who were followed by a pain and palliative care service at an urban cancer center and had at least once expressed a desire for hastened death, describe how both pain and the use of opioid drugs affected their quality of life. Their description is part of a broader phenomenological inquiry on the experience of living with advanced cancer and how that experience affected attitudes towards life and death. Serial, "in-depth semi-structured" interviews were conducted (mean=3 interviews/patient). Themes that emerged in relation to pain and opioid use reflect struggle--with self, with God, and with desire to live and/or readiness to die. Recognizing the appraisal process that patients undertake regarding the cost/benefit of reporting pain and accepting opioids, as well as the impact on severe pain on desire for death, from the patients' own word, gives a framework for the clinician to intervene.
七名晚期癌症患者，他们在一家城市癌症中心接受疼痛与姑息治疗服务，并且至少有一次表达过加速死亡的愿望，他们描述了疼痛和阿片类药物的使用如何影响他们的生活质量。他们的描述是一项关于晚期癌症患者生活经历以及该经历如何影响其生死观的更广泛现象学研究的一部分。研究人员进行了系列“深入的半结构化”访谈（平均每位患者访谈3次）。与疼痛和阿片类药物使用相关出现的主题反映了内心的挣扎——与自我、与上帝、与求生欲望和/或赴死意愿的挣扎。从患者自己的话语中认识到患者对报告疼痛和接受阿片类药物的成本/效益所进行的评估过程，以及严重疼痛对死亡愿望的影响，为临床医生进行干预提供了一个框架。
