University Health Network, Princess Margaret Hospital, Department of Psychosocial Oncology and Palliative Care, Toronto, Ontario, Canada.
Palliat Support Care. 2010 Jun;8(2):227-33. doi: 10.1017/S1478951509990976. Epub 2010 Mar 23.
The primary objective of this article is to elucidate the significance of psychosocial distress and risk in a sub-population of end-stage cancer patients and their spouse caregivers who present with an especially challenging attachment style and histories of childhood trauma. The case study presented highlights the need to both identify and offer an empirically validated couple-based intervention, along with a multi-disciplinary team approach over the trajectory of the illness and at end of life.
A validated marital protocol (emotionally focused couple therapy [EFT]) is modified for this population and conducted by an EFT-trained psychologist as part of a pilot investigation as to the feasibility and effectiveness of EFT for the terminal cancer population. Measures of marital distress, depression, hopelessness, and attachment security are completed at baseline and subsequent intervals, as reported in another publication. Attachment insecurity and the exquisitely intimate relationship with caregiving and care receiving are underscored, given the couple's traumatic childhood history.
The couple described herein, followed from diagnosis of metastatic disease to end of life illuminates the potential effectiveness of a modified EFT protocol, and underscores the need to both identify and intervene with a population potentially at significantly high risk for marital distress, suicidality, depression, and hopelessness.
The benefits of a multidisciplinary team is evident as the patient's symptoms of physical distress increased toward end of life and she returned to earlier behaviors, namely suicidal ideation and an attempt to alleviate her experience of suffering. The strength of the marital bond, possibly as a result of the intervention, and the efforts of the multidisciplinary team approach, demonstrate potential to mitigate a catastrophic end of life and a complicated spousal bereavement. This case study adds to the current empirical literature in an area that is currently under-studied and under-reported.
本文的主要目的是阐明在具有特殊挑战性的依恋风格和童年创伤史的终末期癌症患者及其配偶照顾者亚人群中，心理社会困扰和风险的意义。所呈现的案例研究强调了需要识别和提供经过实证验证的基于夫妻的干预措施，以及在疾病过程中和生命结束时采用多学科团队方法。
为该人群修改了经过验证的婚姻协议（情绪聚焦夫妻治疗[EFT]），并由接受过 EFT 培训的心理学家进行，作为对 EFT 对终末期癌症人群的可行性和有效性进行试点研究的一部分。在另一篇出版物中报告了基线和随后的间隔时间的婚姻困扰、抑郁、绝望和依恋安全性的测量。考虑到夫妻的创伤童年史，依恋不安全感和与照顾和接受照顾的亲密关系被强调。
本文描述的这对夫妇从转移性疾病的诊断到生命结束，说明了修改后的 EFT 方案的潜在有效性，并强调需要识别和干预可能存在婚姻困扰、自杀风险、抑郁和绝望风险显著增加的人群。
多学科团队的优势显而易见，因为患者的身体痛苦症状在生命结束时增加，她回到了更早的行为，即自杀意念和试图减轻她的痛苦体验。夫妻关系的强度，可能是由于干预措施，以及多学科团队方法的努力，有可能减轻灾难性的生命结束和复杂的配偶丧亲之痛。本案例研究增加了当前实证文献中这一目前研究不足和报告不足的领域。
