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疾病不确定性的进一步探索:帕金森病患者照料者的经历

Further explorations of illness uncertainty: carers' experiences of Parkinson's disease.

作者信息

Hurt Catherine S, Cleanthous Sophie, Newman Stanton P

机构信息

a Centre for Health Services Research, School of Health, City, University London , London , UK.

b Modus Outcomes , Letchworth Garden City , UK.

出版信息

Psychol Health. 2017 May;32(5):549-566. doi: 10.1080/08870446.2017.1283041. Epub 2017 Feb 7.

Abstract

OBJECTIVE

Dominant models of illness uncertainty define uncertainty as 'an inability to determine the meaning of illness-related events'. Recent research has shown patient uncertainty to be multidimensional encompassing personal issues indirectly affected by illness. The nature of carer uncertainty has yet to be fully explored. The present study aimed to investigate the nature of illness uncertainty in the carers of patients with Parkinson's disease (PD).

DESIGN

Eighteen carers of a spouse with PD participated in semistructured interviews. Transcripts were thematically analysed, statements were coded as uncertain if they reflected 'a lack of certainty, or a state of limited knowledge, understanding or worry regarding an existing or future outcome'.

RESULTS

The domains of uncertainty expressed by carers closely fitted the five domain framework of patient uncertainty: symptoms and prognosis, medical management, self-management, social functioning and impact. An additional 'carer-role' domain was identified.

CONCLUSIONS

Carer uncertainty about PD went beyond issues directly related to the illness. The findings have implications for research into uncertainty suggesting that widely used measures may not be accurately capturing the nature of carer uncertainty about chronic illness. The breadth of uncertainty reported has implications for the provision of appropriate support to improve caregiver well-being.

摘要

目的

疾病不确定性的主流模型将不确定性定义为“无法确定与疾病相关事件的意义”。近期研究表明,患者的不确定性具有多维度,涵盖了受疾病间接影响的个人问题。而照顾者不确定性的本质尚未得到充分探索。本研究旨在调查帕金森病(PD)患者照顾者的疾病不确定性本质。

设计

18名PD患者配偶的照顾者参与了半结构化访谈。对访谈记录进行了主题分析,如果陈述反映出“对现有或未来结果缺乏确定性,或知识、理解或担忧有限的状态”,则将其编码为不确定。

结果

照顾者表达的不确定性领域与患者不确定性的五领域框架密切契合:症状与预后、医疗管理、自我管理、社会功能和影响。还确定了一个额外的“照顾者角色”领域。

结论

照顾者对PD的不确定性超出了与疾病直接相关的问题。这些发现对不确定性研究具有启示意义,表明广泛使用的测量方法可能无法准确捕捉照顾者对慢性病不确定性的本质。所报告的不确定性广度对提供适当支持以改善照顾者幸福感具有启示意义。

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