Best Megan, Aldridge Lynley, Butow Phyllis, Olver Ian, Webster Fleur
Psycho-Oncology Co-operative Research Group, University of Sydney, Level 6 North, Lifehouse C39Z, New South Wales, 2006, Australia.
Cancer Council Australia, GPO Box 4708, Sydney, New South Wales, 2001, Australia.
Psychooncology. 2015 Sep;24(9):977-86. doi: 10.1002/pon.3795. Epub 2015 Mar 9.
Patient suffering is a neglected area of care, partly because of poor definitions. The aim of this study was to distill what is currently known about suffering in the health literature in order to generate a conceptual basis for further research.
A systematic review focusing on suffering across all cancers was undertaken. The search included peer-reviewed English articles published between 1992 and 2012 in MEDLINE, Embase, PsycINFO and the Cochrane Library databases focusing on conceptualisation of suffering in adult cancer patients. Seminal theoretical articles conceptualising suffering more generally were also eligible. To ensure identification of a sufficiently broad range of conceptualisations of suffering in cancer, the search strategy was drafted iteratively. Study findings were subjected to conceptual analysis using the evolutionary method.
One hundred twenty-eight studies were identified, which discussed definitions or conceptualisations of suffering. In terms of its attributes, suffering is defined as 'an all-encompassing, dynamic, individual phenomenon characterized by the experience of alienation, helplessness, hopelessness and meaninglessness in the sufferer which is difficult for them to articulate. It is multi-dimensional and usually incorporates an undesirable, negative quality.' Surrogate terms, antecedents and consequences of suffering are described.
The systematic review revealed that suffering includes holistic suffering, which is multidimensional, oscillating, individual and difficult for individuals to express. Opportunities should be provided for patients to express their suffering. The potential for suffering to be transcended needs to be recognized and facilitated by healthcare staff.
患者的痛苦是护理中一个被忽视的领域，部分原因是定义不明确。本研究的目的是提炼健康文献中目前关于痛苦的已知内容，以便为进一步研究奠定概念基础。
对所有癌症患者的痛苦进行了系统综述。检索范围包括1992年至2012年间发表在MEDLINE、Embase、PsycINFO和Cochrane图书馆数据库中的同行评审英文文章，重点关注成年癌症患者痛苦的概念化。更广泛地对痛苦进行概念化的开创性理论文章也符合要求。为确保识别出癌症患者痛苦的足够广泛的概念化范围，检索策略经过反复起草。研究结果采用进化方法进行概念分析。
共识别出128项研究，这些研究讨论了痛苦的定义或概念化。就其属性而言，痛苦被定义为“一种无所不包、动态的个体现象，其特征是患者体验到疏离感、无助感、绝望感和无意义感，且难以表达。它是多维度的，通常包含一种不良的负面特质”。还描述了痛苦的替代术语、前因和后果。
系统综述表明，痛苦包括整体痛苦，这种痛苦是多维度的、波动的、个体性的，且个体难以表达。应给患者提供表达痛苦的机会。医护人员需要认识到并促进痛苦被超越的可能性。
