Tishelman Carol, Degner Lesley F, Rudman Ann, Bertilsson Kristina, Bond Ruth, Broberger Eva, Doukkali Eva, Levealahti Helena
Department of Nursing, R and D Unit Foundation, Karolinska Institute, Stockholm, Sweden.
Cancer. 2005 Nov 1;104(9):2013-21. doi: 10.1002/cncr.21398.
The patient perspective on distress associated with lung carcinoma is important, yet understudied. Previous research on symptom experience generally had not differentiated the dimension symptom intensity/frequency from which symptoms are associated with most distress. The objective of the current study was to determine whether patterns of symptom intensity were similar to patterns of symptom distress, whether patterns were consistent at different time points, whether patterns varied by subgroups, and whether high symptom intensity was equivalent to distress.
Four hundred adults who were newly diagnosed with inoperable lung carcinoma completed a measure of symptom intensity/frequency and a new measure of distress associated with symptoms at six time points during the first year after diagnosis. These data were supplemented by field notes by research nurses and by less structured, qualitative interviews.
The mean ranking of distress in the total group and in all subgroups remained constant at all time points, with breathing, pain, and fatigue associated with the most distress. In contrast, the pattern of mean rank order of symptom intensity showed little consistency; however, fatigue had the highest intensity scores at all time points.
The current data challenged the uncritical use of summated scores of different symptom items in the context of lung carcinoma. Breathing and pain appeared to function as icons representing threats associated with lung carcinoma, with distress described as related to the past and the present and to expectations for the future. One of the most promising implications of these data was in fostering a preventive paradigm for symptom palliation.
患者对肺癌相关痛苦的看法很重要，但研究较少。以往关于症状体验的研究通常没有区分症状强度/频率维度与最痛苦相关的症状。本研究的目的是确定症状强度模式是否与症状痛苦模式相似，模式在不同时间点是否一致，模式是否因亚组而异，以及高症状强度是否等同于痛苦。
400名新诊断为无法手术的肺癌的成年人在诊断后的第一年的六个时间点完成了症状强度/频率测量以及与症状相关的痛苦新测量。这些数据由研究护士的现场记录以及结构较松散的定性访谈补充。
所有时间点，总组和所有亚组的痛苦平均排名保持不变，呼吸、疼痛和疲劳与最痛苦相关。相比之下，症状强度的平均排名顺序模式几乎没有一致性；然而，疲劳在所有时间点的强度得分最高。
目前的数据对肺癌背景下不加批判地使用不同症状项目的总分提出了挑战。呼吸和疼痛似乎起到了代表与肺癌相关威胁的标志作用，痛苦被描述为与过去、现在以及对未来的期望有关。这些数据最有前景的影响之一是促进症状缓解的预防模式。
