Mack Jennifer W, Nilsson Matthew, Balboni Tracy, Friedlander Robert J, Block Susan D, Trice Elizabeth, Prigerson Holly G
Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Cancer. 2008 Jun;112(11):2509-17. doi: 10.1002/cncr.23476.
The role of emotional acceptance of a terminal illness in end-of-life (EOL) care is not known. The authors developed a measure of peaceful acceptance at the EOL, and evaluated the role of peaceful acceptance in EOL decision-making and care.
The authors developed the Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE) questionnaire to measure the extent to which patients with advanced cancer have a sense of peaceful acceptance of their terminal illness. The scale was administered to 160 patients with advanced cancer along with measures of other attributes that hypothetically are related to acceptance, including cognitive acceptance of terminal illness. EOL outcomes in 56 patients who died during the study also were examined.
The 12-item PEACE questionnaire had 2 subscales: a 7-item Struggle With Illness subscale (Cronbach alpha = .81) and a 5-item Peaceful Acceptance subscale (alpha = .78). Both subscales were associated with patients' self-reported peacefulness (correlation coefficient [r] = 0.66 for acceptance [P <.0001]; r = -0.37 for struggle [P < .0001]). Struggle With Illness scores were associated with cognitive terminal illness acknowledgment (mean scores, 14.9 vs 12.4 for patients who were not aware that their illness was terminal; P = .001) and with some aspects of advance care planning (living will or healthcare proxy: mean scores, 13.9 vs 11.5; P = .02). In addition, among patients who had died, the use of a feeding tube at the EOL was associated inversely with Peaceful Acceptance (P = .015).
The current study indicated that the PEACE questionnaire is a valid and reliable measure of peaceful acceptance and struggle with illness. Scores were associated with some choices for EOL care among patients with advanced cancer.
在临终关怀中，对绝症的情感接受所起的作用尚不清楚。作者开发了一种临终时平静接受程度的测量方法，并评估了平静接受在临终决策和护理中的作用。
作者编制了癌症经历中的平静、安宁与接受（PEACE）问卷，以测量晚期癌症患者对其绝症的平静接受程度。该量表被施用于160名晚期癌症患者，同时还测量了其他一些假设与接受程度相关的属性，包括对绝症的认知接受。还对研究期间死亡的56名患者的临终结局进行了检查。
12项的PEACE问卷有两个子量表：一个7项的与疾病抗争子量表（克朗巴赫α系数=0.81）和一个5项的平静接受子量表（α系数=0.78）。两个子量表都与患者自我报告的平静程度相关（接受程度的相关系数[r]=0.66[P<.0001]；抗争程度的相关系数[r]=-0.37[P<.0001]）。与疾病抗争得分与对绝症的认知确认相关（平均分，不知道自己病情已到晚期的患者为14.9分，知道的患者为12.4分；P=0.001），也与预先护理计划的某些方面相关（生前遗嘱或医疗代理人：平均分，13.9分对11.5分；P=0.02）。此外，在已死亡的患者中，临终时使用喂食管与平静接受程度呈负相关（P=0.015）。
当前研究表明，PEACE问卷是一种有效且可靠的平静接受和与疾病抗争程度的测量方法。得分与晚期癌症患者临终护理的一些选择相关。
