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患有埃勒斯-当洛斯综合征的患者在诊断的探索之旅中:重新思考复杂性和困难,将其视为英雄的旅程。

Patients with Ehlers-Danlos syndrome on the diagnostic odyssey: Rethinking complexity and difficulty as a hero's journey.

机构信息

Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Department of Anthropology, Indiana University, Indianapolis, Indiana, USA.

出版信息

Am J Med Genet C Semin Med Genet. 2021 Dec;187(4):416-424. doi: 10.1002/ajmg.c.31935. Epub 2021 Sep 15.

Abstract

Patients with hypermobile Ehlers-Danlos syndrome, an hereditary disorder of the connective tissue, often face a long and difficult diagnostic odyssey in pursuit of a name for their condition. Clinicians may dismiss subjective symptoms of chronic pain, thus prolonging patients' odysseys and worsening their care and satisfaction and creating antagonisms in the patient-provider relationship. A greater understanding of patient experiences is necessary in order to decrease burdens of this relationship and to improve care. To that end, we conducted 22 in-depth, semistructured interviews with individuals who had undergone this diagnostic odyssey. We focused on the impact that the odyssey had on their lives, both inside and outside the clinic. Through narrative analysis, we found a sort of "hero's journey" in the description of their cases, highlighting issues of uncertainty and integration as well as honoring their struggles. Interviewees had encountered difficulties in working with clinicians, in multiplying symptoms, and in negative psychosocial consequences. Attention to patients' lived experience may help to build empathy and understanding for the difficult and complex clinical situation presented by Ehlers-Danlos syndrome. Using the hero's journey as a lens onto this experience allows for a more patient-centered approach to this understanding and has potential value for comprehension of other complex diseases and invisible illnesses.

摘要

患有遗传性结缔组织疾病——易位型埃勒斯-当洛斯综合征的患者,在为其病症寻求一个名称的过程中,往往要经历漫长而艰难的诊断之旅。临床医生可能会对慢性疼痛的主观症状不屑一顾,从而延长患者的诊断之旅,使他们的治疗和满意度恶化,并在医患关系中产生对立。为了减轻这种关系的负担并改善护理,有必要更深入地了解患者的体验。为此,我们对经历过这种诊断之旅的 22 人进行了 22 次深入的半结构化访谈。我们关注的是诊断之旅对他们生活的影响,包括诊所内外。通过叙事分析,我们在描述他们的病例时发现了一种“英雄之旅”,强调了不确定性和整合的问题,以及对他们奋斗的尊重。受访者在与临床医生合作、增加症状和应对负面心理社会后果方面遇到了困难。关注患者的生活体验,可能有助于建立对埃勒斯-当洛斯综合征所呈现的困难和复杂临床情况的同理心和理解。使用英雄之旅作为理解这种体验的视角,可以为这种理解提供更以患者为中心的方法,并对理解其他复杂疾病和无形疾病具有潜在价值。

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