探索当代肿瘤姑息治疗中整体疼痛的概念：一项关于患者资源的定性研究

Exploring the concept of Total Pain in contemporary oncology palliative care: a qualitative study on patients' resources.

作者信息

Corman Maya, Dambrun Michaël, Ginzac Angeline, Ménard Katell

机构信息

Université Clermont Auvergne (UCA), LAPSCO UMR CNRS 6024, Clermont-Ferrand, 63000, France.

INSERM U1240 Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Université Clermont Auvergne, Clermont-Ferrand, 63000, France.

出版信息

BMC Palliat Care. 2025 Mar 29;24(1):85. doi: 10.1186/s12904-025-01719-0.

DOI:10.1186/s12904-025-01719-0

PMID:40158100

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11954188/

Abstract

BACKGROUND

According to the concept of Total Pain proposed by Cicely Saunders (1967), the treatment of pain for patients in need of palliative care requires considering its multidimensional nature, encompassing physical, social, psychological, and spiritual aspects. The aim of this study was to update the concept of Total Pain and explore the resources used by patients with cancer.

METHODS

Fourteen semi-structured interviews were conducted in one oncology center and one oncology rehabilitation center (median age = 70.5, range [55-77]; 8 women). The interview guide explored various dimensions of suffering, including physical (e.g., pain), social (e.g., isolation), psychological (e.g., emotional state), and spiritual (e.g., the role of spirituality in illness experience), as well as connections to nature, and patients' internal and external resources related to each sphere of suffering. Interpretative Phenomenological Approach (IPA) was employed to analyze the interviews.

RESULTS

The findings highlight several important aspects of suffering: the unpredictability of pain (physical sphere), loss of social roles (social sphere), negative affects (psychological sphere), evocation of the end of life (spiritual sphere), and loss of contact with nature. Besides in terms of resources, the study identifies several key coping mechanisms, such as mind-body practices for relieving physical and psychological pain, distraction engaging with the environment, nature as a source of positive emotions, and the search for meaning.

CONCLUSIONS

Despite experiencing total pain, some patients utilize internal and external protective resources in the face of life-threatening illness. These findings underscore the importance of viewing Total Pain under its multidimensional aspect and as a dynamic process involving the individual's connection with their community and environment.

TRIAL REGISTRATION

This study received approval from the Ethical Committee of CPP SUD EST 1 (National number: 2019-A02263-54).

摘要

背景

根据西塞莉·桑德斯（1967年）提出的全人疼痛概念，对需要姑息治疗的患者进行疼痛治疗需要考虑其多维度性质，包括身体、社会、心理和精神方面。本研究的目的是更新全人疼痛的概念，并探索癌症患者使用的资源。

方法

在一个肿瘤中心和一个肿瘤康复中心进行了14次半结构式访谈（中位年龄 = 70.5岁，范围[55 - 77岁]；8名女性）。访谈指南探讨了痛苦的各个维度，包括身体方面（如疼痛）、社会方面（如孤立）、心理方面（如情绪状态）和精神方面（如灵性在疾病经历中的作用），以及与自然的联系，和患者与每个痛苦领域相关的内部和外部资源。采用解释现象学方法（IPA）对访谈进行分析。

结果

研究结果突出了痛苦的几个重要方面：疼痛的不可预测性（身体领域）、社会角色的丧失（社会领域）、负面影响（心理领域）、对生命终结的唤起（精神领域）以及与自然联系的丧失。此外，在资源方面，该研究确定了几种关键的应对机制，如缓解身体和心理疼痛的身心练习、与环境互动的注意力分散、自然作为积极情绪的来源以及对意义的探寻。