Salmon P, Manzi F, Valori R M
Department of Clinical Psychology, University of Liverpool, U.K.
Eur J Cancer. 1996 May;32A(5):755-60. doi: 10.1016/0959-8049(95)00643-5.
Clinical observation, systematic research and popular anecdote indicate that, when confronted by death, people change the criteria by which they evaluate their lives. Questionnaires used routinely to assess quality of life in people with poor-prognosis cancer tend to be symptom-based and do not assess factors which become important when confronted by fatal illness, such as the meaning of life and the degree to which life has been enriched by the illness. To develop a questionnaire which would be sensitive to these areas, patients with incurable cancer and carers of such patients were interviewed in depth. Responses were reviewed by a panel of patients, clinicians and carers and formed into an inventory which was completed by 200 similar patients. Principal components analysis identified five dimensions: clearer perception of the meaning of life; freedom versus restriction of life; resentment of the illness; contentment with past and present life; past and present social integration. Only the most symptom-oriented scales (freedom, resentment) correlated with the Rotterdam Symptom Checklist. Scale scores showed that younger patients were more resentful of their illness, but also gained a clearer perception of the meaning of life. This questionnaire can evaluate psychological needs of people with incurable cancer which are neglected by existing instruments.
临床观察、系统研究和大众轶事表明，面对死亡时，人们会改变评价自己生活的标准。常规用于评估预后不良癌症患者生活质量的问卷调查往往基于症状，并未评估面对致命疾病时变得重要的因素，如生命的意义以及疾病使生活丰富的程度。为了开发一份对这些方面敏感的问卷，对晚期癌症患者及其护理人员进行了深入访谈。患者、临床医生和护理人员组成的小组对回答进行了审查，并形成了一份清单，由200名类似患者填写。主成分分析确定了五个维度：对生命意义的更清晰认知；生活的自由与受限；对疾病的怨恨；对过去和现在生活的满足感；过去和现在的社会融合。只有最以症状为导向的量表（自由、怨恨）与鹿特丹症状清单相关。量表得分显示，年轻患者对疾病更怨恨，但对生命的意义也有更清晰的认知。这份问卷可以评估现有工具所忽视的晚期癌症患者的心理需求。
