Manitoba Palliative Care Research Unit, University of Manitoba, Manitoba, Canada.
J Pain Symptom Manage. 2009 Nov;38(5):641-9. doi: 10.1016/j.jpainsymman.2009.04.021. Epub 2009 Aug 26.
Understanding the complexities of distress and knowing who is most vulnerable is foundational to the provision of quality, palliative end-of-life care. Although prior studies have examined the prevalence of symptom distress among patients nearing death, these studies have tended to largely focus on physical and, to a lesser extent, psychological challenges. The aim of this study was to use the Patient Dignity Inventory (PDI), a novel, reliable, and validated measure of end-of-life distress, to describe a broad landscape of distress in patients who are terminally ill. The PDI, a 25-item self-report, was administered to 253 patients receiving palliative care. Each PDI item is rated by patients to indicate the degree to which they experience various kinds of end-of-life distress. Palliative care patients reported an average of 5.74 problems (standard deviation, 5.49; range, 0-24), including physical, psychological, existential, and spiritual challenges. Being an inpatient, being educated, and having a partner were associated with certain kinds of end-of-life problems, particularly existential distress. Spirituality, especially its existential or "sense of meaning and purpose" dimension, was associated with less distress for terminally ill patients. A better appreciation for the nature of distress is a critical step toward a fuller understanding of the challenges facing the terminally ill. A clear articulation of the landscape of distress, including insight regarding those who are most at risk, should pave the way toward more effective, dignity-conserving end-of-life care.
了解痛苦的复杂性并了解谁最脆弱，是提供优质临终关怀的基础。尽管先前的研究已经检查了接近死亡的患者中症状痛苦的发生率，但这些研究往往主要集中在身体上，并且在较小程度上集中在心理挑战上。本研究的目的是使用患者尊严量表（PDI），这是一种新颖，可靠且经过验证的临终痛苦衡量标准，来描述处于绝症末期的患者痛苦的广泛状况。PDI 是一个 25 项自我报告的工具，对接受姑息治疗的 253 名患者进行了评估。每位 PDI 患者都对患者进行了评分，以表明他们经历各种临终痛苦的程度。姑息治疗患者报告的平均问题数为 5.74（标准差为 5.49；范围为 0-24），包括身体，心理，存在和精神挑战。住院，受过教育和有伴侣与某些临终问题相关，特别是存在主义困扰。灵性，尤其是其存在主义或“意义和目的感”维度，与绝症患者的痛苦减轻有关。更好地了解痛苦的性质是更全面地了解绝症患者所面临挑战的关键步骤。明确阐述痛苦的状况，包括对最危险人群的了解，应该为更有效，维护尊严的临终关怀铺平道路。
