Low J T, Payne S
Wessex Institute of Public Health Medicine, Southampton General Hospital, UK.
Eur J Cancer Care (Engl). 1996 Dec;5(4):237-41. doi: 10.1111/j.1365-2354.1996.tb00241.x.
The development of palliative care originated from shortcomings in mainstream health services. Palliative care aims to cater for both the psycho-social needs of dying patients and the allieviation of their physical symptoms. This is reflected by the good and bad death perceptions of palliative care workers, though increasing signs of institutionalization in palliative care have challenged the idealization of a good death. This study aimed to investigate the health professionals' perception of both a good and a bad death and their perception of patients' awareness context. Seventy questionnaires were distributed to nurses and social workers. The 50 returned questionnaires revealed that health professionals perceived a good death as controlling the patients' physical symptoms and psychologically preparing them, whilst a bad death was perceived as the inability to control pain and deal with any psychological distress. Factor analysis identified three main factors (lack of patient distress, patient control and staff's supporting role perceptions) in the perception of a good death whereas four main factors (the negative effect of death on the family, a patient's non-acceptance of death, not dealing with patients' fears and the age of a dying person) were identified with the perception of a bad death. Overall, health professionals perceived themselves to be open and sensitive in communicating with patients although over half felt poorly supported by other staff.
姑息治疗的发展源于主流医疗服务的不足。姑息治疗旨在满足临终患者的心理社会需求并缓解其身体症状。这体现在姑息治疗工作者对善终和恶终的认知上，尽管姑息治疗中越来越多的制度化迹象对善终的理想化提出了挑战。本研究旨在调查卫生专业人员对善终和恶终的认知以及他们对患者意识背景的认知。向护士和社会工作者发放了70份问卷。回收的50份问卷显示，卫生专业人员认为善终是控制患者的身体症状并使其做好心理准备，而恶终则被认为是无法控制疼痛和应对任何心理困扰。因子分析确定了善终认知中的三个主要因素（患者无痛苦、患者掌控和工作人员的支持角色认知），而恶终认知中确定了四个主要因素（死亡对家庭的负面影响、患者对死亡的不接受、未处理患者的恐惧以及临终患者的年龄）。总体而言，卫生专业人员认为自己在与患者沟通时开放且敏感，尽管超过一半的人觉得得到其他工作人员的支持很少。
