Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Palliat Support Care. 2020 Dec;18(6):748-750. doi: 10.1017/S1478951520001121.
Recognizing and managing existential suffering remains challenging. We present two cases demonstrating how existential suffering manifests in patients and how to manage it to alleviate suffering.
Case 1: A 69-year-old man with renal cell carcinoma receiving end-of-life care expressed fear of lying down "as he may not wake up." He also expressed concerns of not being a good Christian. Supportive psychotherapy and chaplain support were provided, with anxiolytic medications as needed. He was able to express his fear of dying and concern about his family, and Edmonton Symptom Assessment System scores improved. He died peacefully with family at bedside. Case 2: A 71-year-old woman presented with follicular lymphoma and colonic obstruction requiring nasogastric drain of fecaloid matter. Initially, she felt that focusing on comfort rather than cure symbolized giving up but eventually felt at peace. Physical symptoms were well-controlled but emotionally she became more distressed, repeatedly asking angrily, "Why is it taking so long to die?." She was supported by her family through Bible readings and prayers, but she was distressed about being a burden to them. An interdisciplinary approach involving expressive supportive counseling, spiritual care, and integrative medicine resulted in limited distress relief. Owing to increasing agitation, the patient and family agreed to titrate chlorpromazine to sedation. Her family was appreciative that she was restful until her death.
Existential suffering manifests through multiple domains in each patient. A combination of pharmacologic and non-pharmacologic techniques may be needed to relieve end-of-life suffering.
识别和处理存在主义痛苦仍然具有挑战性。我们呈现了两个案例，展示了存在主义痛苦如何在患者身上表现出来，以及如何管理它以减轻痛苦。
案例 1：一位 69 岁的男性患有肾细胞癌，正在接受临终关怀，他表达了害怕躺下的恐惧，因为他可能无法醒来。他还担心自己不是一个好基督徒。提供了支持性心理治疗和牧师支持，并按需使用了抗焦虑药物。他能够表达自己对死亡的恐惧和对家人的担忧，埃德蒙顿症状评估系统评分有所改善。他在家人的陪伴下平静地去世。案例 2：一位 71 岁的女性患有滤泡性淋巴瘤和结肠梗阻，需要进行鼻胃管引流粪便样物质。最初，她觉得专注于舒适而不是治疗象征着放弃，但最终她感到平静。身体症状得到了很好的控制，但她在情感上变得更加痛苦，反复愤怒地问：“为什么死得这么慢？”她得到了家人的支持，通过阅读圣经和祈祷来支持她，但她为成为家人的负担而感到痛苦。多学科方法包括表达性支持咨询、精神关怀和整合医学，在一定程度上缓解了痛苦。由于烦躁不安加剧，患者和家属同意滴定氯丙嗪以镇静。她的家人很感激她在去世前一直很平静。
存在主义痛苦在每个患者身上通过多个领域表现出来。可能需要结合药物和非药物技术来缓解临终痛苦。
