Salander P, Bergenheim T, Henriksson R
Department of Oncology, Umeå University, Sweden.
Soc Sci Med. 1996 Apr;42(7):985-96. doi: 10.1016/0277-9536(95)00204-9.
The malignant brain tumour disease condenses much of the anguish of cancer diseases. The brain is a vital and delicate organ, and the prognosis is generally unfavourable. The patient is exposed and has to rely on cognitive manoeuvres to manage the mental stress. The purpose of this study was to generate new insights into how the patient constructs a new sense of reality when confronted with the malignant brain tumour diagnosis. Within grounded theory methodology, 30 patients with malignant gliomas were interviewed twice, in direct connection with diagnosis, surgery and radiotherapy. In addition, their partners were interviewed, and quantitative instruments (SMMSE, RDCQ) were used as additional references for assessing the patients cognitively and emotionally. Eleven patients were excluded from the final analysis because of cognitive impairment of personality change. Most of the patients were aware of the fact that the brain tumour exposed them to grave danger, but they were also able to use various cognitive manoeuvres to create protection and hope. This process originated from different sources: the body; helpful relations; cognitive schemata; and the handling of information. The importance of the body to raise hope is emphasized. In the discussion we consider this process as an expression of how the patient brings together reality and hope, thus creating her/his own illusion. These findings are also related to adjacent psychoanalytic theory, proposing a theoretical reference with clinical implications when discussing "What to tell cancer patients."
恶性脑肿瘤疾病浓缩了癌症疾病的诸多痛苦。大脑是一个至关重要且脆弱的器官，其预后通常不容乐观。患者处于暴露状态，不得不依靠认知策略来应对精神压力。本研究的目的是深入了解患者在面对恶性脑肿瘤诊断时如何构建新的现实感。在扎根理论方法的框架内，对30例恶性胶质瘤患者在诊断、手术和放疗期间进行了两次访谈。此外，还对他们的伴侣进行了访谈，并使用定量工具（简易精神状态检查表、快速抑郁症状问卷）作为评估患者认知和情感状况的额外参考。由于认知障碍或人格改变，11例患者被排除在最终分析之外。大多数患者意识到脑肿瘤使他们面临严重危险，但他们也能够运用各种认知策略来创造保护感和希望。这个过程源于不同的来源：身体；有益的人际关系；认知图式；以及信息处理。强调了身体对唤起希望的重要性。在讨论中，我们将这个过程视为患者如何将现实与希望结合起来，从而创造出自己的幻想的一种表现。这些发现也与相邻的精神分析理论相关，在讨论“该对癌症患者说什么”时提出了具有临床意义的理论参考。
