Johnston Nikki, Chapman Michael, Gibson Jo, Paterson Catherine, Turner Murray, Strickland Karen, Liu Wai-Man, Phillips Christine, Bail Kasia
Faculty of Health, University of Canberra, Building 10, 11 Kirinari Street, Bruce, Australia, ACT Health Directorate, Canberra, ACT, Bruce, ACT 2617, Australia.
Synergy Nursing and Midwifery Research Centre, Australia.
Palliat Care Soc Pract. 2024 Sep 28;18:26323524241277851. doi: 10.1177/26323524241277851. eCollection 2024.
Symptoms of emotional and physical stress near death may be related to previous experiences of trauma.
To investigate current evidence regarding the following: (1) Is previous trauma identified in people who are dying, and if so, how? (2) How is previous trauma associated with the experience of death/dying in people with or without cognitive impairment? and (3) What palliative care interventions are available to people with previous trauma at the end of life?
This integrative review was conducted per Whittemore and Knafl's guidelines, which involves a stepped approach, specifically (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis and (5) presentation.
This integrative review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases were searched in August 2021 and updated in August 2023. The articles were quality appraised, and narrative data were analysed using Grounded Theory (GT).
Of 1310 studies screened, 11 met the inclusion criteria (four qualitative and seven quantitative) conducted in Australia, Canada, Japan and the United States; and American studies accounted for 7/11 studies. Eight were focused on war veterans. Descriptive studies accounted for the majority, with only two publications testing interventions. Re-living trauma near death has additional features to a diagnosis of post-traumatic stress disorder alone, such as physical symptoms of uncontrolled, unexplained acute pain and this distress was reported in the last weeks of life.
This study proposes that re-living trauma near death is a recognisable phenomenon with physical and psychological impacts that can be ameliorated with improved clinical knowledge and appropriate management as a new GT. Further research is needed to enable past trauma identification at the end of life, and trauma-informed safe interventions at the end of life are an urgent need.
濒死时的情绪和身体应激症状可能与既往创伤经历有关。
调查关于以下方面的现有证据：（1）在濒死之人中是否能识别出既往创伤，若能，如何识别？（2）既往创伤如何与有或无认知障碍的人的死亡/濒死体验相关联？以及（3）临终时曾有过创伤的人可获得哪些姑息治疗干预措施？
本整合性综述按照惠特莫尔和克纳夫的指南进行，该指南涉及一种逐步推进的方法，具体包括（1）问题识别、（2）文献检索、（3）数据评估、（4）数据分析和（5）呈现。
本整合性综述依据系统评价和Meta分析的首选报告项目（PRISMA）指南进行报告。2021年8月对电子数据库进行了检索，并于2023年8月更新。对文章进行质量评估，并使用扎根理论（GT）对叙述性数据进行分析。
在筛选的1310项研究中，有11项符合纳入标准（4项定性研究和7项定量研究），这些研究在澳大利亚、加拿大、日本和美国开展；其中美国的研究占11项研究中的7项。8项研究聚焦于退伍军人。描述性研究占多数，仅有两篇出版物测试了干预措施。濒死时重温创伤具有一些仅诊断为创伤后应激障碍之外的额外特征，例如无法控制、无法解释的急性疼痛的身体症状，且这种痛苦在生命的最后几周被报告。
本研究提出，濒死时重温创伤是一种可识别的现象，具有身体和心理影响，作为一种新的扎根理论，通过提高临床知识和适当管理可得到改善。需要进一步研究以在生命末期识别既往创伤，并且生命末期基于创伤知情的安全干预措施迫在眉睫。
