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从钙过敏的定性角度汲取经验,在重症期间处理医患关系。

Navigating the patient-provider relationship during severe illness with lessons from a qualitative perspective of calciphylaxis.

作者信息

Durant Olivia G, Nigwekar Sagar U, Salhi Carmel

机构信息

Kidney Research Center, Massachusetts General Hospital, Boston, MA, USA.

Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.

出版信息

Sci Rep. 2025 Jul 2;15(1):23515. doi: 10.1038/s41598-025-09116-6.

Abstract

Calciphylaxis is a condition with unpredictable onset that predominantly affects people with kidney disease. This rare, incredibly painful condition results in necrotic skin lesions caused by calcified occlusions of the microvasculature and has an average one-year mortality rate of 50%. There is no cure for calciphylaxis, and treatment primarily focuses on symptom management. We sought to understand the lived experience of calciphylaxis. This qualitative study utilized semi-structured, phenomenological interviewing. We created a code table in which primary codes were analyzed from the biopsychosocial perspective from which overarching domains of experience were identified. Our sample consisted of 15 outpatient participants: 9 were in remission from calciphylaxis while 6 had active disease. Twelve participants were women while 3 were male. Participants ages ranged from 38 - 80 (mean 59). The calciphylaxis patient experience was characterized by severe pain, a lack of adequate pain management, limited calciphylaxis literacy among providers, and complicated interpersonal relationships with family, friends, and medical providers. Calciphylaxis is a life-altering condition characterized by severe pain and uncertainty on multiple fronts. This study demonstrates that clinical management of rare, severe illnesses, such as calciphylaxis, requires clear, honest provider-patient communication, sufficient provider and patient education, adequate symptom management, and empathy.

摘要

钙过敏是一种发病不可预测的病症,主要影响肾病患者。这种罕见且极其疼痛的病症会导致因微血管钙化阻塞而引起的坏死性皮肤损伤,平均一年死亡率为50%。钙过敏无法治愈,治疗主要集中在症状管理上。我们试图了解钙过敏患者的生活经历。这项定性研究采用了半结构化的现象学访谈方法。我们创建了一个编码表,从生物心理社会角度分析主要编码,并从中确定总体体验领域。我们的样本包括15名门诊参与者:9名已从钙过敏中缓解,6名患有活动性疾病。12名参与者为女性,3名男性。参与者年龄在38岁至80岁之间(平均59岁)。钙过敏患者的经历特点是剧痛、疼痛管理不足、医疗服务提供者对钙过敏的认知有限,以及与家人、朋友和医疗服务提供者之间复杂的人际关系。钙过敏是一种改变生活的病症,其特点是在多个方面都存在剧痛和不确定性。这项研究表明,对于像钙过敏这样罕见的严重疾病,临床管理需要医患之间清晰、坦诚的沟通,对医疗服务提供者和患者进行充分的教育,进行充分的症状管理以及具备同理心。

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