Garg Rajat, Chauhan Vinay, Sabreen B
Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India.
Indian J Palliat Care. 2018 Oct-Dec;24(4):491-495. doi: 10.4103/IJPC.IJPC_63_18.
Patients in palliative care suffer variously due to underassessment of needs and suboptimal intervention, coupled with lack of access to palliative care. This study attempts to identify effective coping strategies which lead to life satisfaction, among those afflicted with terminal cancer.
This observational, cross-sectional study was carried out among terminally-ill cancer patients undergoing palliative care. Cancer patients receiving palliative care who give consent and were aged 18 years or older were included in the study. Those with cognitive deficits, delirium, or psychosis were excluded from the study. COPE scale, Temporal Satisfaction with Life Scale, and sociodemographic Performa were administered and analyzed. Pearson's correlation coefficient test and multiple linear regression analyses were used to evaluate correlation and effect of coping strategies on life satisfaction.
Religious coping was the most frequently used coping strategy by patients, followed by acceptance. Females showed higher problem-focused coping, whereas males had higher emotion-focused and avoidant coping strategies. Females manifested more religious coping. Males showed more acceptance of their illness. Those without a partner had significantly higher emotion-focused coping strategies and higher religious coping. Income, social support, and problem-oriented coping were positively related to quality of life. Life satisfaction showed significant negative correlation with denial, substance use, and venting utilized as coping methods.
Problem-focused coping (religious coping and acceptance) was found to be more effective than other methods. Patients in palliative care could be instructed for the use of problem-focused coping. Such training might enhance their life satisfaction, helping them experience greater control over the course of illness.
姑息治疗中的患者因需求评估不足、干预措施欠佳以及无法获得姑息治疗而遭受各种痛苦。本研究试图在晚期癌症患者中确定能带来生活满意度的有效应对策略。
本观察性横断面研究在接受姑息治疗的晚期癌症患者中进行。纳入研究的是接受姑息治疗且年龄在18岁及以上并同意参与的癌症患者。认知缺陷、谵妄或精神病患者被排除在研究之外。使用了应对方式量表、生活满意度量表和社会人口学调查表并进行分析。采用Pearson相关系数检验和多元线性回归分析来评估应对策略与生活满意度之间的相关性和影响。
宗教应对是患者最常使用的应对策略，其次是接受。女性表现出更高的以问题为导向的应对方式，而男性则有更高的以情绪为导向和回避的应对策略。女性表现出更多的宗教应对。男性对自己的疾病表现出更多的接受。没有伴侣的人有显著更高的以情绪为导向的应对策略和更高的宗教应对。收入、社会支持和以问题为导向的应对与生活质量呈正相关。生活满意度与作为应对方式的否认、物质使用和发泄呈显著负相关。
发现以问题为导向的应对方式（宗教应对和接受）比其他方式更有效。可以指导姑息治疗中的患者使用以问题为导向的应对方式。这样的培训可能会提高他们的生活满意度，帮助他们在疾病过程中体验到更大的掌控感。
