恶性肿瘤临终病人生命末期尊严体验的质性研究

目的:了解恶性肿瘤临终病人生命末期的尊严体验,为改善照护质量提供参考依据。方法:采用目的抽样方法选取2022年7月—2023年8月在杭州市4所三级医院住院的18例恶性肿瘤临终病人,对其尊严体验进行半结构式访谈,采用内容分析法进行资料分析,提炼主题。结果:恶性肿瘤临终病人的尊严体验归纳为3个主题：对尊严的理解、尊严受损的因素、尊严得到维护的因素。结论:医护人员可通过改善工作态度、提升临床照护质量、多学科协作、实施个性化照护、建立良好的社会支持系统改善恶性肿瘤临终病人的尊严体验,提升生命末期的生存质量。     

基于CiteSpace的国内外临终尊严护理研究热点的可视化分析

目的:分析近15年国内外临终尊严护理研究发展现状,探讨研究热点前沿,为我国今后开展临终尊严护理研究提供借鉴。方法:检索中国知网(CNKI)和Web of Science(WoS)数据库中收录的临终尊严护理相关文献,运用CiteSpace软件从文献检索量、作者、研究机构、期刊分布、关键词聚类、突现词等方面分析研究现状和热点前沿。结果:共纳入中文文献301篇和英文文献695篇,发文量呈逐年增长趋势。国外形成以Chochinov HM、Onwuteaka-philipsen BD、Pasman HRW为中心的核心作者群,机构间合作紧密,国内以万忠艳、王莉、吴瑾、刘小红、吴梅利洋、曾铁英,张秀华、陈玲、李怡玮等的研究最为活跃,但尚未形成核心作者群。国内的研究热点集中于临终关怀、尊严疗法、生前预嘱、死亡教育和伦理问题,研究对象主要是老年人群和晚期癌症病人;国外的研究热点集中于尊严疗法及效果评价、护患沟通、预先护理计划、学科交叉研究和家庭照护,研究对象主要是老年人和青少年。结论:国内临终尊严护理研究尚处于初级阶段,有待借鉴国外研究经验,加强国内与国际合作,完善临终尊严护理干预模式,为提高临终病人尊...     

尊严疗法在癌症领域的研究现状及热点分析

目的:运用文献计量学的方法,全面分析尊严疗法在癌症领域的研究现状、热点及发展趋势,旨在为进一步的研究提供参考和借鉴。方法:基于Web of Science数据库核心合集和中国知网(CNKI)数据库,借助CiteSpace V软件对尊严疗法在癌症领域的相关文献进行可视化分析并绘制知识图谱。结果:共筛选出304篇文章(英文文献207篇,中文文献97篇),国内外发文总体呈上升趋势,国外2022年为发文高峰,国内发文高峰出现于2018年;发文最多的国家为加拿大,发文最多机构为曼尼托巴大学,载文量最多的期刊为JOURNAL OF PAIN AND SYMPTOM MANAGEMENT,发文最多的作者为Chochinov Harvey Max。国外研究主要集中在癌症终末期病人的生活质量、心理护理、安宁疗护实施等方面,国内的研究研究对象逐渐从癌症病人聚焦到其照顾者的身上,考虑照顾负担等问题。结论:癌症病人尊严问题的相关研究日益火热,我国学者在该领域的关注度有待提升,未来可借鉴国外前沿热点,结果我国文化背景,形成具有中国特色的尊严干预体系,丰富尊严疗法的内涵。     

尊严疗法在安宁疗护实践中的应用

尊严疗法是一种个体化心理干预,其目的是提升疾病终末期患者生命意义感和尊严,减轻临终痛苦。尊严疗法由经过培训的医务人员引导,以尊严疗法问题提纲为指导,采用访谈录音的形式为临终患者提供一个讲述重要人生经历,分享内心感受、情感和智慧的机会。录音资料被转录、编辑,转化为一份传承文档,让患者分享给家属,以缓减家属的丧亲之痛并给予家属慰藉。在我国安宁疗护实践中推广尊严疗法,需要在引进基本概念和模式的基础上对其进行本土化改造或创新。     

尊严疗法改善临终患者希望水平、尊严状况、负性情绪有效性的系统评价与Meta分析

目的 系统评价尊严疗法改善临终患者希望水平、尊严状况及负性情绪有效性,为临床医护人员开展尊严疗法提供参考。方法 计算机检索PubMed,Embase,Cochrane Library,Web of Science,中国知网,万方数据库,中国生物医学文献数据库,维普数据库中有关尊严疗法改善临终患者希望水平和负性情绪的随机对照试验,检索时间为2005年1月至2021年9月。2名研究者独立根据Cochrane系统评价方法对纳入文献进行质量评价和资料提取,采用RevMan 5.3软件进行Meta分析。结果 共纳入17篇随机对照试验（randomized controlled trial,RCT）,1 581例患者,Meta分析结果显示：尊严疗法可以提升患者的希望水平[MD=4.68,95%CI(3.02,6.34),P<0.001];亚组分析：改善其尊严（patient dignity inventory,PDI）[SMD=-0.80,95%CI(-1.57,-0.04),P=0.04],尊严（status self-esteem scale,SSES）[SMD=1.82,95%CI(1...     

基于Web of Science的尊严疗法研究文献计量分析

目的采用文献计量法对尊严疗法的研究现状与研究热点进行分析。方法以2012-01-01—2021-12-31 10年间Web of Science收录的文献为研究对象,从年度发文量、国家/地区分布、机构分布、发文期刊、高影响力作者及关键词等进行分析。结果 以360篇尊严疗法为主题的文献,发文量总体呈螺旋式上升趋势;发文量前3的国家依次是美国、德国、加拿大;发文量排名前10的机构主要来自于英国、美国、加拿大、澳大利亚和德国;发文量最多、总被引频次最多的作者是加拿大曼尼托巴大学的Chochinov Harvey Max教授;刊文量前3的期刊为《Palliative Medicine》《Palliative Supportive Care》和《Journal of Pain And Symptom Management》;针对特定人群的尊严疗法,以及如何具体实施尊严疗法是该领域的重要支撑点。结论 关于尊严疗法的研究,国际上已形成核心作者群,相关研究热点也已凸显。国内学者可跟踪相关作者的研究成果,跟踪学术前沿和热点,有针对性选择期刊进行投稿,提升学术影响力和学术话语权。     

尊严疗法在晚期癌症患者中应用的研究进展

随着医学技术的发展,癌症患者的生命终末期可能延长,但并未明显成功提高癌症的治愈率[1]。晚期癌症患者生命的延长,患者身体机能日益衰退,生存质量日益下降,对照顾者的生活依赖程度愈加强烈。同时患者的隐私不受保护,自我价值逐渐丧失,从而使患者的自尊心下降、尊严受损[2]。研究报道[3],我国晚期癌症患者的尊严丧失率53.3%~63.3%,较CHOCHINOV等[4]报道的5.3%~7.5%高。尊严作为安宁疗护的哲学基础,是患者心理健康的重要组成部分[5],但我国安宁疗护重在改善患者的躯体症状和疼痛控制,对心理支持方面相对欠缺[6]。CHOCHINOV等[7]于2005年在尊严模型为理论框架的基础上提出尊严疗法。尊严疗法作为安宁疗护中一种较新颖的心理干预方法,在改善尊严感、心理健康和整体生化质量方面显示出较好的效果[8]。国外对尊严疗法的研究已较成熟,但在我国还处于初级探索阶段,因此本研究对尊严疗法展开综述,以期为临床护理提供参考,现报道如下。     

三级综合医院恶性肿瘤患者终末期死亡态度及优逝需求质性研究

目的:探讨三级综合医院恶性肿瘤患者临终阶段对死亡的态度、优逝的需求与期望,为终末期患者的安宁疗护提供依据.方法:采用现象学研究的方法对11例恶性肿瘤终末期患者死亡和优逝的话题进行深入访谈、资料分析.结果:肿瘤终末期患者对待死亡包括2个主题:讨论死亡的时机、死亡态度,对优逝需求、期望包括4个主题和10个副主题:生理需求(...     

终末期癌症患者尊严照护的研究进展

癌症是严重威胁人类生存和社会发展的疾病,全球范围内其发病率和病死率呈逐年上升趋势。《"健康中国"2030规划纲要》明确要求推进健康中国建设,为人民群众提供全方位、全周期的健康服务。终末期癌症患者面临死亡威胁,饱受躯体及心理症状痛苦。国外多项研究证实,尊严照护有助于优化终末期癌症患者的生命意义,提高其总体生存满意度。目前国内在该领域的研究尚处于起步阶段,仍存在一些影响其发展的制约因素。本文通过检索国内外文献,对尊严照护的起源发展、实施内涵及未来挑战等内容进行综述,以期引起国内同行关注,为维护终末期癌症患者尊严,促进我国尊严照护发展提供参考依据。     

终末期肾病患者信息实践动机的质性研究

目的探索终末期终末期肾病患者信息实践动机,以期为构建终末期肾病患者信息需求评估体系和健康教育策略提供依据。方法目的抽样法选取8名终末期肾病患者或家属进行个体面对面半结构深度访谈,运用解释现象学研究的主题分析法对访谈内容进行主题分析。结果信息期望值、压力与担忧、与服务提供者的亲缘性和信息实践效能等4个主题框架被呈现。结论护士应密切结合患者信息实践动机,采用适当的教育方法激发患者有效的信息实践,并对患者实施持续动态且有效的规范健康教育。     

Dignity and psychotherapeutic considerations in end-of-life care

The basic tenets of palliative care are frequently subsumed under the goal of helping patients to die with dignity. Our research group has studied the issue of dignity, with dying patients serving as the primary informants. This paper reviews some of our findings, including an overview of the Dignity Model that derives from our empirical work. Furthermore, this paper summarizes various psychotherapeutic approaches which have been considered for this vulnerable patient population. Finally, we provide the rationale based on the Dignity Model for a psychotherapeutic intervention we have coined Dignity Therapy. This brief, individualized therapeutic approach has been informed by our dignity work, and specifically designed for application in patients nearing death.     

Dignity-conserving care: application of research findings to practice

A central tenet of palliative care is to help people die with "dignity". The widespread use of this term presupposes that this construct is well understood from the perspective of the terminally ill, and that the factors that bolster or erode dignity are known. However, the paucity of research related to these issues suggests otherwise. Over the past 5 years, this research team, headed by Dr Chochinov, has undertaken a programme of research aimed at explicating what dignity means to those who are terminally ill, and identifying those factors that support and undermine dignity in this patient population. This article will provide a synopsis of that work, with an emphasis on the application of research findings for practice.     

The patient dignity inventory: a novel way of measuring dignity-related distress in palliative care

Quality palliative care depends on a deep understanding of distress facing patients nearing death. Yet, many aspects of psychosocial, existential and spiritual distress are often overlooked. The aim of this study was to test a novel psychometric—the Patient Dignity Inventory (PDI)—designed to measure various sources of dignity-related distress among patients nearing the end of life. Using standard instrument development techniques, this study examined the face validity, internal consistency, test–retest reliability, factor structure and concurrent validity of the PDI. The 25-items of the PDI derive from a model of dignity in the terminally ill. To establish its basic psychometric properties, the PDI was administered to 253 patients receiving palliative care, along with other measures addressing issues identified within the Dignity Model in the Terminally Ill. Cronbach's coefficient alpha for the PDI was 0.93; the test–retest reliability was r = 0.85. Factor analysis resulted in a five-factor solution; factor labels include Symptom Distress, Existential Distress, Dependency, Peace of Mind, and Social Support, accounting for 58% of the overall variance. Evidence for concurrent validity was reported by way of significant associations between PDI factors and concurrent measures of distress. The PDI is a valid and reliable new instrument, which could assist clinicians to routinely detect end-of-life dignity-related distress. Identifying these sources of distress is a critical step toward understanding human suffering and should help clinicians deliver quality, dignity-conserving end-of-life care.     

Requests to forgo potentially life-prolonging treatment and to hasten death in terminally ill cancer patients: a prospective study

This study investigates the background and evolution of requests to forgo treatment and hasten death in terminally ill cancer patients. Physicians participating in a nationwide study on end-of-life decision making were asked whether they were treating a terminally ill cancer patient whose life expectancy was longer than 1 week but no longer than 3 months and who they would continue to treat until the patient's death. Of the 120 physicians who had a patient who met the inclusion criteria, 85 (70.8%) completed a questionnaire each month until the patient's death. The questionnaire provided information on the patient's symptoms, concerns, and requests involving end-of-life decisions. Most patients suffered from cancer of the gastrointestinal tract or the respiratory system, and 66% died within 2 months of the initial interview. The prevalence of requests involving end-of-life decisions increased during the last 3 months of a patient's life. The evolution of a request was especially related to an increase in the number of severe symptoms and concerns. Requests to forgo treatment were related to general weakness, whereas loss of dignity was a major reason for requests to hasten death. Physical suffering alone appeared to lead to less drastic requests than suffering blended by concerns and psychological problems leading to requests for hastened death. The results emphasize the importance of gaining insight into the patients' suffering to provide meaningful assistance.     

Dignity conserving care at end-of-life: A narrative review

Purpose of the researchThis narrative literature review uses systematic principles to define evidence regarding dignity conserving care at end-of-life from published research on dignity or distress in end-of-life care.MethodsThe Chochinov model of dignity was used as a pre-defined framework. Articles were reviewed using thematic analysis to produce a synthesis of findings. A total of 39 articles (26 qualitative and 13 quantitative) fulfilled the inclusion criteria and were found to give suggestions on care actions.Key resultsSeveral care actions were identified related to all themes contained within the Dignity Model, except aftermath concerns. Examples include: controlling symptoms; listening to the patient and taking them seriously; providing advice concerning how to cope on a daily basis; treating patients as equals and with respect, and; encouraging the family members’ presence.ConclusionsEvidence for supporting palliative care services has previously been found to be weak in determining solutions to meet individual’s important needs. Drawing together primary research, as in this study, is therefore of importance. The suggested care actions will be used to develop a dignity care pathway for end-of-life care, which is currently being evaluated by the authors. The intention is to provide more valid evidence for the effectiveness of the care actions suggested.     

Maintainance of patients' dignity during hospitalization: Comparison of staff–patient observations and patient feedback through interviews

Patients' rights such as the need for dignity and respect are essential in the provision of quality care. This exploratory clinical study explored patient dignity within the acute hospital environment through observation of staff–patient interactions and interviews with patients. Dignity can be influenced through two major mediums—maintenance of the physical environment and the communication style of the nurse. The findings identified deviations to ideal practice in the maintenance of the physical environment and communication styles of the nursing staff. Maintenance of dignity and privacy were not identified by patients during the interviews as being under threat despite deviations to ideal practice being observed. Patients possibly accept that 'ideal practice' is not always provided to them because nurses are 'busy', or other factors take precedence in this environment. It is possible that a prevailing culture influences patients' perceptions of whether dignity is maintained.     

A concept analysis of dignity for older adults

BACKGROUND: Human dignity is an essential value of professional nursing education as well as a component of the American Nurses Association Code of Ethics. Nurses are exhorted to treat patients with dignity, and older adults want to be treated with dignity and die with dignity. Although dignity, particularly the dignity of older adults, is often discussed in the health care literature, its meaning is not always clear. AIM: The aim of this paper is to describe a concept analysis to develop a definition of dignity in older adults. METHODS: Data were collected using a literature review and five focus groups composed of older adults. The literature provided data about professionals' ideas of dignity and the focus groups provided qualitative data about the nature of dignity in older people. The literature review and focus groups were carried out concurrently, followed by synthesis of the findings. FINDINGS: Dignity is an inherent characteristic of being human, it can be subjectively felt as an attribute of the self, and is made manifest through behaviour that demonstrates respect for self and others. Dignity must be learned, and an individual's dignity is affected by the treatment received from others. CONCLUSIONS: A behavioural definition of dignity was constructed and this could provide the theoretical basis for nurses to develop interventions that foster dignity for older people.     

Care with dignity: a concept analysis

The attribute of dignity depends on the perspective of the individual and can be affected by interactions with others. Dignity involves the day-to-day choices by which individuals create who they will become and how they will be perceived in the context of human culture. Dignified care requires a caregiver-patient relationship that values autonomy, individual diversity, truth, justice, rights, and responsibilities. Because authoritative practice does not acknowledge the rights and dignity of others, those who have power must constrain themselves and use caution in applying judgement.     

Human dignity in paediatrics: the effects of health care

Human dignity is grounded in basic human attributes such as life and self-respect. When people cannot stand up for themselves they may lose their dignity towards themselves and others. The aim of this study was to elucidate if dignity remains intact for family members during care procedures in a children's hospital. A qualitative approach was adopted, using open non-participation observation. The findings indicate that dignity remains intact in family-centred care where all concerned parties encourage each other in a collaborative relationship. Dignity is shattered when practitioners care from their own perspective without seeing the individual in front of them. When there is a break in care, family members can restore their dignity because the interruption helps them to master their emotions. Family members' dignity is shattered and remains damaged when they are emotionally overwhelmed; they surrender themselves to practitioners' care, losing their self-esteem and self-respect.