Lee Virginia, Loiselle Carmen G
McGill University Health Centre, Montreal, Quebec, Canada.
School of Nursing and Department of Oncology, Faculty of Medicine, McGill University, Quebec, Canada.
Palliat Support Care. 2012 Jun;10(2):123-33. doi: 10.1017/S1478951511000745. Epub 2012 Mar 30.
Despite significant improvement in cancer survival, the fear of death still remains rooted in individuals' beliefs about cancer. Existential fears pertaining to cancer cut across the cancer control continuum and taint decisions related to prevention, screening, surveillance, and follow-up recommendations, as well as the overall management of cancer-related issues. However, individuals are innately predisposed to cope with their cancer-related fears through mechanisms such as reliance on the process of meaning making. To better appreciate the potential impact of existential concerns across the cancer control continuum, the Temporal Existential Awareness and Meaning Making (TEAMM) model is proposed. This tripartite model depicts three types of perceived threats to life related to cancer including a "social awareness" (i.e., cancer signals death), "personalized awareness" (i.e., I could die from cancer), and the "lived experience" (i.e., It feels like I am dying from cancer). This construal aims to enhance our understanding of the personal and contextual resources that can be mobilized to manage existential concerns and optimize cancer control efforts. As such, existential discussions should be considered in any cancer-related supportive approach whether preventive, curative, or palliative, and not be deferred only until the advanced stages of cancer or at end of life. Further delineation and validation of the model is needed to explicitly recognize and depict how different levels of existential awareness might unfold as individuals grapple with a potential, actual, or recurrent cancer.
尽管癌症生存率有了显著提高,但对死亡的恐惧仍然深深植根于个人对癌症的认知中。与癌症相关的生存恐惧贯穿癌症控制的全过程,并影响与预防、筛查、监测、后续建议以及癌症相关问题的整体管理等相关的决策。然而,个体天生倾向于通过诸如依赖意义建构过程等机制来应对与癌症相关的恐惧。为了更好地理解生存问题在癌症控制全过程中的潜在影响,提出了时间性生存意识与意义建构(TEAMM)模型。这个三方模型描述了与癌症相关的三种对生命的感知威胁,包括“社会意识”(即癌症意味着死亡)、“个性化意识”(即我可能死于癌症)和“实际体验”(即感觉自己正在死于癌症)。这种解释旨在增进我们对可用于管理生存问题和优化癌症控制工作的个人及情境资源的理解。因此,在任何与癌症相关的支持性方法中,无论是预防性、治愈性还是姑息性的,都应考虑进行生存问题的讨论,而不应仅推迟到癌症晚期或生命末期。需要对该模型进行进一步的细化和验证,以明确认识和描述当个体面对潜在、实际或复发性癌症时,不同程度的生存意识可能如何呈现。