Ahluwalia Sangeeta, Reddy Neha K, Johnson Rebecca, Emanuel Linda, Knight Sara J
RAND Corporation, Santa Monica, California, USA.
UCLA Fielding School of Public Health, Los Angeles, California, USA.
J Palliat Med. 2020 Sep;23(9):1177-1183. doi: 10.1089/jpm.2019.0444. Epub 2020 Feb 28.
We previously developed the reintegration model to describe the adjustment process for individuals at the end of life. However, caregivers and loved ones also require significant support and must work to reimagine their relationship with one another. We sought to develop a dyadic version of the reintegration model that delineates key parts of the adjustment process that occur between the patient and another significant person rather than as two separate individuals. We refined an initial conceptual model of this dyadic process with findings from a narrative literature review on spousal dyadic mutuality. We assessed emergent themes regarding dyadic adjustment from the literature for their fit with our original reintegration model and through consensus discussion, applied the findings to a final proposed conceptual model of dyadic reintegration at the end of life. Examples of dyadic adjustment in the literature relate to the comprehension, creative adaptation, and reintegration processes described in the original reintegration model. Evidence also supported three substantive additions in the new dyadic model: (1) shared understanding that the harmony of the dyad is interrupted; (2) consideration of the "we" (the dyad) and the "I" (the individual) in mutual reflection to create a shared narrative; and (3) emphasis on relationship as a factor impacting adjustment processes. Available evidence supports interdependent relationships between members of dyads for the three adaptation processes of comprehension, creative adaptation, and reintegration in the model. This dyadic reintegration model can be useful in clinical practice to support dyads facing life-limiting illness.
我们之前开发了再整合模型来描述临终个体的调整过程。然而，照顾者和亲人也需要大量支持，并且必须努力重新构想他们彼此之间的关系。我们试图开发一种二元版本的再整合模型，该模型描绘了患者与另一个重要人物之间发生的调整过程的关键部分，而不是将他们视为两个独立的个体。我们利用对配偶二元相互性的叙述性文献综述结果，完善了这个二元过程的初始概念模型。我们从文献中评估了有关二元调整的新出现主题与我们原始再整合模型的契合度，并通过共识讨论，将这些结果应用于最终提出的临终二元再整合概念模型。文献中二元调整的例子与原始再整合模型中描述的理解、创造性适应和再整合过程相关。证据还支持在新的二元模型中有三个实质性补充：（1）共同认识到二元关系的和谐被打破；（2）在相互反思中考虑“我们”（二元关系）和“我”（个体）以创造共同叙事；（3）强调关系是影响调整过程的一个因素。现有证据支持二元关系成员之间在模型中的理解、创造性适应和再整合这三个适应过程中的相互依存关系。这种二元再整合模型在临床实践中可能有助于支持面临生命有限疾病的二元关系。
