Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada.
Cancer Nurs. 2012 May-Jun;35(3):178-86. doi: 10.1097/NCC.0b013e31822786f6.
A basic tenet of palliative care is to maintain an individual's control over the dying process. However, when decline occurs quickly, as may be the case in advanced cancer, transition of responsibility for illness management to a family caregiver may become necessary when care takes place in the home.
The aim of this study was to understand the decision-making process that occurs between a dying individual and his or her family caregiver.
Participants in this grounded theory study were selected by purposive and theoretical sampling methods. Data were collected and analyzed using a constant comparison approach.
The core category covering captured the inordinate efforts taken by informal caregivers to ensure that their family member would be able to die in the manner of his or her choosing. The basic social process, dancing on the stairs, chronicled the families' decision-making process as they navigated through this delicate and precarious end stage of life.
Dancing on the stairs required a close relationship between 2 people who were willing to remain engaged with each other, despite the difficulties they faced. This decision-making process may be applicable to other health care transitions in people's lives that need to be managed with another person.
Palliative care education for nurses in all care health settings may ease transitions for end-stage patients. Health promotion initiatives designed to educate the lay public about advance directives and end-stage illness management in a home setting may help to prepare family caregivers for their future responsibilities.
姑息治疗的一个基本原则是保持个人对临终过程的控制。然而，当衰退迅速发生时，如在晚期癌症中可能出现的情况，当在家中进行护理时，可能需要将疾病管理的责任过渡给家庭照顾者。
本研究旨在了解临终个体与其家庭照顾者之间发生的决策过程。
通过目的性和理论性抽样方法选择本扎根理论研究的参与者。使用恒定性比较方法收集和分析数据。
涵盖的核心类别捕捉到了非正式照顾者为确保其家庭成员能够按照自己的意愿去世而付出的过多努力。基本的社会过程“在楼梯上跳舞”记录了家庭在这一微妙而脆弱的生命末期的决策过程。
在楼梯上跳舞需要两个人之间建立密切的关系，他们愿意尽管面临困难，但仍保持彼此的互动。这一决策过程可能适用于人们生活中需要与他人共同管理的其他医疗保健过渡。
姑息治疗教育可以为所有护理环境中的护士提供帮助，使晚期患者的过渡更加顺利。旨在教育公众了解预立指示和家庭环境中晚期疾病管理的健康促进计划，可能有助于为家庭照顾者未来的责任做好准备。
