Shanfield S B
Hillside J Clin Psychiatry. 1983;5(1):31-42.
The experience of a psychiatric consultant to the inpatient and bereavement components of a hospice is reported. The bulk of the consultation is to the hospice staff. Activities of the consultant include attendance at a weekly patient care meeting and patient and staff groups, consultation with the bereavement team and the administrative leadership, and the evaluation of patients. Clarification of the inevitable psychologic problems that arise in dealing with the mostly elderly very ill patients with end-stage cancer as well as with their families is a major function. Many of the problems special to the hospice relate to loss, mourning, and death. Psychiatric diagnostic input has been helpful in the treatment of organic and functional psychiatric disorders including the treatment of the emotional components of pain and disordered grief which is manifest as depression. Consultation is provided to individuals at risk of problems in the bereavement period. The psychiatric consultant to a hospice is helpful in establishing and maintaining a sensitive therapeutic system of care for the patient and family. He provides an important presence and a forum for the discussion of psychologic issues for the staff. In addition, he has an important role in clarifying the psychodynamic issues involved with death, loss, and mourning for the patient, family, and staff. He provides input around the treatment of functional and organic psychiatric problems seen in the patient and family. Such activities require the continuing membership and leadership of a psychiatrist on the hospice team. The hospice is a laboratory for the understanding of death, loss, and mourning. Although they have been the subject of much inquiry, these issues can be studied fruitfully at the hospice because of the accessibility to dying patients and the bereaved, both before and after the death of their loved one (Kubler-Ross, 1970; Parkes, 1972; Schoenberg, Carr, Kutscher, Peretz, and Goldberg, 1974; Jacobs and Ostfeld, 1977; Kastenbaum and Costa, 1977; Greenblatt, 1978). Much remains to be learned about the processes and outcomes of mourning, as well as dying styles and character styles and family variables as they relate to death. Psychologic principles around the care of the dying and their families that have application to other settings (Shanfield, 1978; Shanfield, 1982) need to be clarified in the hospice setting.
本文报告了一位精神科顾问在临终关怀机构的住院部和丧亲者关怀部门的工作经历。大部分咨询工作是针对临终关怀机构的工作人员。顾问的活动包括参加每周的患者护理会议以及患者和工作人员小组会议，与丧亲者关怀团队和行政领导进行咨询，并对患者进行评估。处理大多数患有晚期癌症的老年重病患者及其家人时不可避免出现的心理问题的澄清是一项主要职责。临终关怀机构特有的许多问题都与丧失、哀悼和死亡有关。精神科诊断意见有助于治疗器质性和功能性精神障碍，包括治疗疼痛的情感成分以及表现为抑郁的紊乱性悲伤。为处于丧亲期有问题风险的个人提供咨询。临终关怀机构的精神科顾问有助于为患者及其家人建立并维持一个敏感的治疗护理体系。他为工作人员提供了重要的存在以及一个讨论心理问题的平台。此外，他在为患者、家人和工作人员阐明与死亡、丧失和哀悼相关的心理动力学问题方面发挥着重要作用。他为患者及其家人中出现的功能性和器质性精神问题的治疗提供意见。此类活动需要精神科医生持续成为临终关怀团队的成员并发挥领导作用。临终关怀机构是一个理解死亡、丧失和哀悼的实验室。尽管这些问题一直是许多研究的主题，但由于在亲人去世前后都能接触到临终患者和丧亲者，因此在临终关怀机构可以卓有成效地研究这些问题（库布勒 - 罗斯，1970年；帕克斯，1972年；舍恩伯格、卡尔、库彻、佩雷茨和戈德堡，1974年；雅各布斯和奥斯特菲尔德，1977年；卡斯滕鲍姆和科斯塔，1977年；格林布拉特，1978年）。关于哀悼的过程和结果，以及与死亡相关的死亡方式、性格特点和家庭变量，仍有许多有待了解的地方。适用于其他环境的临终患者及其家人护理的心理原则（尚菲尔德，1978年；尚菲尔德，1982年）需要在临终关怀环境中加以澄清。
