Glaus A, Crow R, Hammond S
Department of Nursing, University of Surrey, Guildford, UK.
Eur J Cancer Care (Engl). 1996 Jun;5(2 Suppl):8-23. doi: 10.1111/j.1365-2354.1996.tb00247.x.
Interest in fatigue research has grown since the finding that fatigue/tiredness is the most frequently reported symptom of cancer and its treatment. But even though several authors have tried to conceptualize fatigue (Piper & Rieger, 1989; Cimprich, 1992; Gibson & Edwards, 1985; Winningham, 1994; Irvine et al. 1994; Grandjean, 1970; et al.), its mechanisms are still poorly understood. The aim of this study was two-fold: i) to explore fatigue in cancer patients, inductively, and ii) to compare fatigue/tiredness experiences of healthy individuals with those of cancer patients to identify cancer-specific fatigue/tiredness and related concepts. A qualitative research strategy was adopted using a grounded-theory approach. The prospective study took place in the Oncology Department of the Kantonsspital St Gallen (Switzerland) with samples of 20 cancer patients and 20 healthy individuals. Unstructured, tape-recorded interviews were conducted to collect data. Transcripts of the interviews were analysed using content analysis and constant comparison. Although different themes emerged between the two groups, both fitted a classification system that categorized expression of fatigue/tiredness as physical, affective or cognitive. Physical signs were more frequent than affective and cognitive signs in both groups. For the cancer patients, fatigue involved decreased physical performance, extreme, unusual tiredness, weakness and an unusual need for rest, which was distinctly different for healthy persons. Affective and cognitive distress were also more prominent in cancer patients. Interestingly, the concept of malaise was not identified by either sample and not understood as an expression of fatigue by this German-speaking population. Linguistic differences in the description of fatigue/tiredness between healthy and ill individuals revealed different perceptions of the phenomenon. A step-like theory, involving nociception, perception and expression of tiredness, was put forward tentatively to explain the production of fatigue/tiredness. The emerging concepts break tiredness/fatigue into expressions of physical, affective and cognitive tiredness/fatigue. The experience is different between healthy individuals and cancer patients. The generalization of data needs precaution but the results of the study identify and clarify ideas that might form an important basis for further, controlled studies.
自从发现疲劳/疲倦是癌症及其治疗中最常报告的症状以来，对疲劳研究的兴趣与日俱增。尽管有几位作者试图对疲劳进行概念化（Piper & Rieger，1989年；Cimprich，1992年；Gibson & Edwards，1985年；Winningham，1994年；Irvine等人，1994年；Grandjean，1970年等），但其机制仍未得到充分理解。本研究的目的有两个：一是归纳探索癌症患者的疲劳情况；二是比较健康个体与癌症患者的疲劳/疲倦体验，以识别癌症特异性疲劳/疲倦及相关概念。采用扎根理论方法的定性研究策略。前瞻性研究在瑞士圣加仑州立医院肿瘤科进行，样本包括20名癌症患者和20名健康个体。通过非结构化的录音访谈收集数据。访谈记录采用内容分析和持续比较的方法进行分析。尽管两组之间出现了不同的主题，但两者都符合一个分类系统，该系统将疲劳/疲倦的表现分为身体、情感或认知方面。两组中身体症状都比情感和认知症状更频繁。对于癌症患者来说，疲劳表现为身体机能下降、极度异常的疲倦、虚弱以及对休息的异常需求，这与健康人明显不同。情感和认知困扰在癌症患者中也更为突出。有趣的是，两组样本均未识别出不适的概念，且这个说德语的人群也不将其理解为疲劳的一种表现。健康个体和患病个体在描述疲劳/疲倦时的语言差异揭示了对该现象的不同认知。初步提出了一个涉及伤害感受、疲倦感知和表达的阶梯状理论来解释疲劳/疲倦的产生。新出现的概念将疲倦/疲劳细分为身体、情感和认知疲倦/疲劳的表现。健康个体和癌症患者的体验不同。数据的推广需要谨慎，但该研究结果识别并阐明了一些观点，这些观点可能为进一步的对照研究奠定重要基础。
