Southwell Phillipa Jane, Crockett Judith, Burton Deborah, Gullifer Judith
a Faculty of Science , Three Rivers University Department of Rural Health, Charles Sturt University , Orange , Australia.
b Faculty of Science, School of Community Health , Charles Sturt University , Orange , Australia.
COPD. 2018 Oct;15(5):439-445. doi: 10.1080/15412555.2018.1487390.
There is considerable research regarding the adaption to functional decline associated with advanced (Stage IV) Chronic Obstructive Pulmonary Disease (COPD). This research has, however, primarily focused on physical and interventional strategies to manage disease progression and symptom burden, as opposed to the psychosocial strategies. To address this paucity, the current research explored the psychosocial strategies people with Stage IV COPD use to maintain quality of life towards the end of life. Eleven older people with Stage IV COPD living in regional Australia were interviewed to explore their experiences of ageing with COPD. The research used a theory-led analysis, informed by a Gadamerian hermeneutic phenomenological methodology, to examine participant data in relation to selection, optimisation and compensation theory (SOC). The participant stories reflected the use of selective strategies, from which a hierarchy of priority tasks emerged. Participants optimised their capacity to perform high priority tasks using a range of pragmatic and instinctive responses to ongoing change, which became more and more conscious and deliberate over time. Additionally, compensatory strategies more traditionally associated with COPD management were used to reduce the impact of symptoms. It is through the participant descriptions and perception of optimisation and compensation strategies and how they were implemented that the wider theme of 'mind over matter' emerged. The use of these strategies to adapt physically and psychosocially to COPD shows how the participants demonstrated resilience and used 'successful ageing' strategies to cope with ongoing functional decline.
关于晚期（IV期）慢性阻塞性肺疾病（COPD）患者如何适应功能衰退，已有大量研究。然而，这些研究主要集中在控制疾病进展和减轻症状负担的身体及干预策略上，而非心理社会策略。为填补这一空白，当前研究探索了IV期COPD患者在生命末期用以维持生活质量的心理社会策略。对居住在澳大利亚地区的11名老年IV期COPD患者进行了访谈，以探究他们患COPD后的衰老经历。该研究采用了以理论为导向的分析方法，以伽达默尔诠释现象学方法为依据，依据选择、优化与补偿理论（SOC）来审视参与者的数据。参与者的故事反映了他们所采用的选择性策略，从中浮现出了一系列优先任务的层级。参与者通过对持续变化做出一系列务实且本能的反应，来优化自己执行高优先级任务的能力，随着时间推移，这些反应变得越来越有意识和深思熟虑。此外，还采用了一些更传统上与COPD管理相关的补偿策略，以减轻症状的影响。正是通过参与者对优化和补偿策略的描述及认知，以及这些策略的实施方式，“精神战胜物质”这一更广泛的主题得以浮现。运用这些策略在身体和心理社会层面适应COPD，展示了参与者如何展现出复原力，并运用“成功老龄化”策略来应对持续的功能衰退。
