背景:亨廷顿病(HD),一个无法治愈的人,多代人,常染色体显性疾病,在受影响的人及其家庭照顾者中创造独特的挑战和无数与精神相关的压力源。精神上的痛苦,悲伤/损失的经历,和应对策略尚未在HD护理人员中进行系统研究。
目的:为了全面定义精神苦难,悲伤/损失,以及HD护理人员使用的应对策略。
方法:进行了PRISMA-ScR范围研究文献综述。使用归纳和开放编码对纳入研究文章的数据进行主题组织。一个接地的,演绎法被用来划定主题的划界分类法,其中包括所有三个总体领域。四位审稿人,采用改进的德尔菲方法,确定研究参与者在每项研究中展示了哪些主题。
结果:583篇文章中的36篇符合审查标准;没有一篇发表在姑息治疗文献中。调查主要集中在内心(自我形象)的痛苦和存在的焦虑;只有很少看到更深入的神/超个人的痛苦,破坏了宗教关系,或者意味着痛苦。HD护理人员经历深刻的悲伤/损失,表达为被剥夺权利的悲伤,与他们所爱的人的模棱两可的损失有关,家庭结构的丧失,社会联系,和个人损失。一半的研究报告了适应不良的HD照顾者应对策略,其特征是功能失调的逃避方案;相比之下,超越/创造性的策略往往是未经探索的。
结论:HD看护者经历了长时间的悲伤和其他形式的精神痛苦,因为他们逐渐失去亲人和破坏自己的生活。有了改进的评估工具,由精神和姑息治疗专家组成的团队将能够更好地支持HD家庭护理人员。
Huntington\'s disease (HD), an incurable, multi-generational, autosomal dominant disorder, creating unique challenges and a myriad of spiritually-related stressors in those affected and their familial caregivers. Spiritual suffering, experiences of grief/loss, and coping strategies have not been systematically studied in HD caregivers.
To comprehensively define spiritual suffering, grief/loss, and coping strategies used by HD caregivers.
A PRISMA-ScR scoping literature
review was conducted. Data from included research articles were organized thematically using induction and open coding. A grounded, deductive approach was used to delineate a demarcated taxonomy of themes, which encompasses all three over-arching domains. Four reviewers, employing a modified Delphi approach, ascertained which themes were demonstrated by research participants in each study.
36 of 583 articles met the
review criteria; none were published in the palliative care literature. Investigations primarily focused on intrapersonal (self-image) distress and existential angst; only rarely looking deeper into divine/transpersonal suffering, disrupted religious relationships, or meaning distress. HD caregivers experience profound grief/loss, expressed as disenfranchised grief that is associated with the ambiguous loss of their loved one, loss of family structure, social connectedness, and personal losses. Half of the studies reported maladaptive HD caregiver coping strategies-characterized by dysfunctional escape schemes; in contrast, transcendent/creative strategies were often unexplored.
HD caregivers experience prolonged grief and other forms of spiritual suffering as they progressively lose their loved ones and disruption to their own lives. With an improved assessment tool, teams with spiritual and palliative care experts will better be able to support HD family caregivers.