Golla Heidrun, Mammeas Stephanie, Galushko Maren, Pfaff Holger, Voltz Raymond
Department of Palliative Medicine,University Hospital of Cologne,Cologne,Germany.
Institute for Medical Sociology,Health Services Research and Rehabilitation Science (IMHR),Faculty of Human Science and Faculty of Medicine,University of Cologne,Cologne,Germany.
Palliat Support Care. 2015 Dec;13(6):1685-93. doi: 10.1017/S1478951515000607. Epub 2015 Jun 17.
Multiple sclerosis (MS) patients' caregivers are sometimes considered as "hidden patients." How much more this might be true for caregivers of severely affected MS patients has so far been scarcely studied. Palliative care also addressing relatives' needs might therefore be very relevant for these caregivers. However, we do not yet know which unmet needs they have and how these could be met. Our aim was to gain an insight into the subjectively unmet needs of caregivers of severely affected MS patients in Germany.
The study employed a qualitative cross-sectional approach for assessing unmet needs. Twelve caregivers of severely affected MS patients were recruited using a convenience sampling approach. Face-to-face interviews were conducted, audiotaped, and transcribed verbatim, followed by qualitative content analysis.
Unmet needs were sorted into the following categories: "relationship to physician," "individual support by the healthcare system," "relationship to the individual severely affected by MS," "end-of-life issues," "self-care," and "higher awareness of MS." Caregivers tended to group the unmet needs of their care recipients with their own and rarely focused on their own wishes and restrictions.
A close patient-caregiver dyad makes it difficult to differentiate unmet caregiver needs. However, the palliative care approach might help caregivers of severely affected MS patients by answering questions on disease progress and end-of-life issues, as well as by offering respite care, support for self-care, and help in preserving one's identity, and also anticipating the time to come after the death.
多发性硬化症(MS)患者的照料者有时被视为“隐性患者”。对于重症MS患者的照料者而言,这种情况在多大程度上更甚,目前鲜有研究。因此,满足亲属需求的姑息治疗可能与这些照料者密切相关。然而,我们尚不清楚他们有哪些未满足的需求以及如何满足这些需求。我们的目的是深入了解德国重症MS患者照料者主观上未满足的需求。
本研究采用定性横断面方法评估未满足的需求。采用便利抽样法招募了12名重症MS患者的照料者。进行了面对面访谈,录音并逐字转录,随后进行定性内容分析。
未满足的需求分为以下几类:“与医生的关系”、“医疗系统的个人支持”、“与重症MS患者的关系”、“临终问题”、“自我照料”以及“对MS的更高认识”。照料者倾向于将其照料对象未满足的需求与自己的需求归为一类,很少关注自身的愿望和限制。
患者与照料者的紧密二元关系使得区分照料者未满足的需求变得困难。然而,姑息治疗方法可能有助于重症MS患者的照料者,通过回答有关疾病进展和临终问题,提供喘息护理、自我照料支持以及帮助保持个人身份认同,还能对患者去世后的未来有所预期。