The Royal Marsden NHS Foundation Trust, London, UK.
J Clin Nurs. 2013 May;22(9-10):1442-54. doi: 10.1111/jocn.12095. Epub 2013 Mar 19.
To explore the meaning of end-of-life care for critically ill cancer patients, families, oncologists, palliative care specialists, critical care consultants and nurses.
End-of-life care for critically ill patients, of whom nearly 20% will die in critical care, remains somewhat problematic (Truog et al. 2008). End-of-life care is an established domain in cancer; however, research has not been conducted previously into dying, critically ill cancer patients' experiences.
Qualitative, phenomenological in-depth interviews were undertaken.
Phenomenology was used to explore experiences of 27 participants: surviving patients at high risk of dying, bereaved families, oncologists, palliative and critical care consultants, and nurses. Purposive sampling from a UK critical care unit was carried out. In-depth interviews were taped analysed using Van Manen's phenomenological analysis framework.
A phenomenological interpretation of dying in cancer critical illness, and the impact on opportunities for end-of-life care, is presented. Three main themes included: dual prognostication; the meaning of decision-making; and care practices at end of life: choreographing a good death. End-of-life care was an emotive experience for all participants; core tenets for good end-of-life care included comfort, less visible technology, privacy and dignity. These findings are discussed in relation to end-of-life care, cancer and critical illness.
The speed of progressing towards dying in critical illness is often unknown and subsequently affects potential for end-of-life care. Caring was not unique to nurses and end-of-life care in critical care came with considerable emotional cost.
There is an opportunity for nurses to use the care of patients dying in critical care to develop specialist knowledge and lead in care, but it requires mastery and reconciliation of both technology and end-of-life care. Healthcare professionals can help facilitate acceptance for families and patients, particularly regarding involvement in decisions and ensuring patient advocacy.
探索临终关怀对重病癌症患者、家属、肿瘤学家、姑息治疗专家、重症监护顾问和护士的意义。
对近 20%将在重症监护中死亡的重病患者的临终关怀仍存在一些问题（Truog 等人，2008 年）。临终关怀是癌症领域的一个既定领域；然而，以前没有对临终、重病癌症患者的经历进行过研究。
进行了定性、现象学深入访谈。
使用现象学探索了 27 名参与者的经验：处于高死亡风险的幸存患者、失去亲人的家属、肿瘤学家、姑息治疗和重症监护顾问以及护士。从英国重症监护病房进行了有目的的抽样。对深度访谈进行录音分析，使用 Van Manen 的现象学分析框架。
提出了癌症重症疾病中死亡的现象学解释，以及对临终关怀机会的影响。三个主要主题包括：双重预后预测；决策的意义；和临终关怀实践：编排一个美好的死亡。临终关怀对所有参与者来说都是一种情感体验；良好临终关怀的核心原则包括舒适、不太显眼的技术、隐私和尊严。这些发现与临终关怀、癌症和重症疾病有关。
在重症疾病中走向死亡的速度往往是未知的，从而影响了临终关怀的可能性。护理不仅仅是护士的职责，重症监护中的临终关怀伴随着相当大的情感成本。
护士有机会利用重症监护中死亡患者的护理来发展专业知识并领导护理，但这需要掌握和协调技术和临终关怀。医疗保健专业人员可以帮助促进家庭和患者的接受，特别是在参与决策和确保患者权益方面。
