Kissane David W
Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Arch Intern Med. 2012 Oct 22;172(19):1501-5. doi: 10.1001/archinternmed.2012.3633.
Advanced and progressive illnesses bring existential suffering to patients as an inevitable consequence of the disease and its treatment. Physicians need a typology of existential distress to aid its recognition and improved management. The major forms of existential challenge include (1) death anxiety, (2) loss and change, (3) freedom with choice or loss of control, (4) dignity of the self, (5) fundamental aloneness, (6) altered quality of relationships, (7) our search for meaning, and (8) mystery about what seems unknowable. An adaptive response to each challenge promotes equanimity, peace, and fulfillment while sustaining engagement with life, creativity, and joy. Physicians can do much to nurture courage and maintain each person's sense of meaning, value, and purpose.
晚期和进行性疾病不可避免地会给患者带来因疾病及其治疗而产生的生存痛苦。医生需要一种生存困扰的类型学来帮助识别和改善对其的管理。生存挑战的主要形式包括：（1）死亡焦虑；（2）丧失与变化；（3）选择的自由或失去控制；（4）自我尊严；（5）基本的孤独感；（6）人际关系质量的改变；（7）我们对意义的探寻；（8）对似乎不可知之事的神秘感。对每一项挑战的适应性反应能促进平静、安宁和满足，同时维持对生活、创造力和快乐的投入。医生可以在培养勇气以及维护每个人的意义感、价值观和目标感方面大有作为。
