Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
J Pain Symptom Manage. 2012 Jul;44(1):52-63. doi: 10.1016/j.jpainsymman.2011.07.013. Epub 2012 May 30.
Fatigue is a prevalent, debilitating, and often disruptive symptom for cancer patients. Yet, it remains inadequately understood and managed, especially among late middle-aged and older patients with advanced disease. Few studies have explored fatigue qualitatively, and almost none have focused on patients' attributions for this subjective and multidimensional symptom.
Our objectives were to 1) examine the attributions patients aged 55 years or older with advanced cancer made for their fatigue and how they arrived at these attributions and 2) understand how patients' attributions affect how they contend with fatigue, including communication with health care providers.
We conducted qualitative in-depth interviews with 35 patients aged 55 years or older on their experiences with fatigue. Patients had a variety of cancers and were at stages IV or late III of the disease. Interviews were thematically coded and analyzed.
Two main themes emerged: 1) Cancer-related treatment was the master and often the sole attribution patients made for their fatigue. Patients making this attribution expressed certainty about its accuracy and seemed less distressed about the symptom. 2) Multiple causes of fatigue, typically a combination of cancer, treatment, and nonthreatening causes (e.g., older age, overexertion, or anemia), also were offered by some. Patients seemed to resist identifying disease severity as a cause and appeared motivated to normalize and minimize the symptom, thus decreasing its threatening impact.
Patients' causal attributions for fatigue had a profound effect on their physical and psychological well-being, their communication with providers, and their integration of the symptom into their lives.
疲劳是癌症患者普遍存在的、使人虚弱的，且常常具有破坏性的症状。然而，它仍然没有得到充分的理解和管理，尤其是在患有晚期疾病的中老年患者中。很少有研究从定性角度探讨疲劳，几乎没有研究关注患者对这种主观的、多维症状的归因。
我们的目的是 1）考察年龄在 55 岁及以上的晚期癌症患者对其疲劳的归因，以及他们是如何得出这些归因的，2）了解患者的归因如何影响他们应对疲劳的方式，包括与医疗保健提供者的沟通。
我们对 35 名年龄在 55 岁及以上的患者进行了深入的定性访谈，了解他们的疲劳经历。患者患有各种癌症，处于疾病的第四阶段或晚期第三阶段。访谈采用主题编码和分析。
出现了两个主要主题：1）癌症相关治疗是患者对疲劳的主要归因，也是他们的唯一归因。做出这种归因的患者对其准确性表示肯定，对症状的困扰程度较低。2）一些患者还提出了疲劳的多种原因，通常是癌症、治疗和非威胁性原因（如年龄较大、过度劳累或贫血）的组合。患者似乎不愿意将疾病的严重程度确定为病因，似乎有动力将症状正常化和最小化，从而降低其威胁性影响。
患者对疲劳的因果归因对他们的身心健康、与提供者的沟通以及他们将症状融入生活的方式都有深远的影响。
