Fisher Simon, Colyer Hazel
Pilgrims Hospices, East Kent, United Kingdom.
Int J Palliat Nurs. 2009 Nov;15(11):548-53. doi: 10.12968/ijpn.2009.15.11.45494.
There is very little research into patients who suffer from a terminal and progressive illness making decisions about health care in a hospice setting. What decision-making means to the inpatients in a hospice could be better understood by staff caring for this patient group. The aim of this small qualitative study was to explore the nature of decisions and the process of decision-making with patients who had been admitted to a hospice with a progressive terminal illness. A phenomenological approach was taken using a theoretical framework to explore the patients' life world and its existential meaning, and interviews were conducted with six inpatients. The decisions that came to the fore for the participants were around the driving force behind admission, which was often pain. Beyond this often traumatic event they were able to be robust in decision-making about day-to-day issues. Other decisions related to the purpose of the admission such as symptom control, achieving independence, whether to have further treatment, communication with their families and returning to the community. Patients had an increased awareness of the fragility of their existence, which was brought into focus by the decision to be admitted to the hospice. The findings give an insight into the driving forces behind decision-making and the kind of decisions that are important to the patients in this sample, which staff caring for this patient group may find valuable.
对于患有晚期进行性疾病的患者在临终关怀机构中做出医疗保健决策的研究非常少。照顾这一患者群体的工作人员可能会更好地理解决策对临终关怀机构住院患者意味着什么。这项小型定性研究的目的是探讨患有晚期进行性疾病并入住临终关怀机构的患者的决策性质和决策过程。采用现象学方法，运用理论框架来探索患者的生活世界及其存在意义，并对六名住院患者进行了访谈。参与者面临的突出决策围绕入院背后的驱动力，这通常是疼痛。在这个往往具有创伤性的事件之后，他们能够在日常问题的决策上表现得很坚定。其他决策与入院目的相关，如症状控制、实现独立、是否接受进一步治疗、与家人沟通以及回归社区。患者对自身存在的脆弱性有了更高的认识，而入住临终关怀机构的决定使这一点更加凸显。研究结果揭示了决策背后的驱动力以及对该样本中的患者来说重要的决策类型，照顾这一患者群体的工作人员可能会发现这些结果很有价值。
