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胶质母细胞瘤幸存者与脱节感

Surviving glioblastoma and a sense of disconnection.

作者信息

Gately L, McLachlan S A, Dowling A, Philip J

机构信息

St Vincent's Hospital, Victoria, Australia.

St Vincent's Hospital, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia.

出版信息

J Clin Neurosci. 2020 Nov;81:284-289. doi: 10.1016/j.jocn.2020.10.012. Epub 2020 Oct 19.

Abstract

Given the poor prognosis of glioblastoma, little focus has been placed on the needs of long-term survivors (those alive at least two years following diagnosis). The aim of this project was to explore the lived experience of long-term survivors of glioblastoma using a qualitative approach. Long-term survivors of glioblastoma diagnosed between 1/1/2006-31/12/2016 were identified at the tertiary centre involved. Participants underwent a semi-structured qualitative interview and caregiver dyads were collected if available. Thematic analysis was undertaken where themes were gradually generated from the data alongside data collection and confirmed or contrasted as data collection proceeded. Participants were selected and interviewed until data saturation was reached at 10 interviews. The overarching theme explaining the data was a sense of disconnection, beginning with the shock of diagnosis, and evolving over time, leading survivors to feel disconnected from (1) 'who I was', redefining their work, independence and social self; (2) 'who I am', contributing to social isolation, disavowal, and anxiety and depression; and (3) 'who I could be', reassessing their future. This unique study highlights the acute emotional distress and disconnection that begins with diagnosis and its evolving impact on the lived experience. Clinicians need to consider the emotional impact of survival when managing these patients and adopt a holistic approach, including the early introduction of psychosocial support to patients and their caregivers. Further validation of these findings in a larger cohort is desirable.

摘要

鉴于胶质母细胞瘤的预后较差,长期幸存者(诊断后至少存活两年的患者)的需求很少受到关注。本项目的目的是采用定性研究方法,探索胶质母细胞瘤长期幸存者的生活经历。在参与研究的三级医疗中心识别出2006年1月1日至2016年12月31日期间被诊断为胶质母细胞瘤的长期幸存者。参与者接受了半结构化定性访谈,如有可能,还收集了照顾者二元组的数据。进行了主题分析,在数据收集过程中,主题逐渐从数据中产生,并随着数据收集的进行得到确认或对比。选择参与者并进行访谈,直到在10次访谈时达到数据饱和。解释这些数据的总体主题是一种脱节感,始于诊断时的震惊,并随着时间的推移而演变,导致幸存者感到与以下方面脱节:(1)“过去的我”,重新定义他们的工作、独立性和社交自我;(2)“现在的我”,导致社会隔离、自我否定以及焦虑和抑郁;(3)“未来的我”,重新评估他们的未来。这项独特的研究突出了从诊断开始的急性情绪困扰和脱节及其对生活经历不断演变的影响。临床医生在管理这些患者时需要考虑生存带来的情绪影响,并采取整体方法,包括尽早为患者及其照顾者提供心理社会支持。在更大的队列中对这些发现进行进一步验证是很有必要的。

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