{"id":5277,"date":"2021-10-18T20:00:36","date_gmt":"2021-10-18T17:00:36","guid":{"rendered":"https:\/\/bcuni.eu\/tr\/?p=5235"},"modified":"2021-10-18T20:00:36","modified_gmt":"2021-10-18T17:00:36","slug":"doktor-hasta-iliskisi-ve-iletisimsel-sorunlar","status":"publish","type":"post","link":"https:\/\/bcuni.eu\/tr\/doktor-hasta-iliskisi-ve-iletisimsel-sorunlar\/","title":{"rendered":"DOKTOR-HASTA \u0130L\u0130\u015eK\u0130S\u0130 VE \u0130LET\u0130\u015e\u0130MSEL SORUNLAR"},"content":{"rendered":"\n

Yrd. Do\u00e7. Dr. Mustafa YA\u011eBASAN<\/strong><\/p><\/blockquote>\n\n\n\n

Sa\u011fl\u0131k hizmetleri profesyonelleri, hastalar ve kanser bak\u0131m\u0131na olan holistik yakla\u015f\u0131m\u0131n \u00f6neminde genel halk aras\u0131nda bilin\u00e7lilik artm\u0131\u015ft\u0131r. B\u00fct\u00fcnleyici tedavileri de i\u00e7eren psikososyal engellemeler kanserli insanlar\u0131n hayat kalitesini (QoL) d\u00fczeltmek i\u00e7in te\u015fhisle ba\u011flant\u0131l\u0131 olarak s\u0131k\u0131nt\u0131y\u0131 azalmaya yard\u0131mc\u0131 olarak ve d\u00fczeltilmi\u015f psikolojik ayarlama kanser deneyimini kolayla\u015ft\u0131rarak yard\u0131mc\u0131 olabilir. A\u015fa\u011f\u0131daki makale kendi QoL\u2019lerinde ya\u015fam kalitesi \u00fczerine refleksolojinin yararlar\u0131nda m\u00fc\u015fterilerin alg\u0131lar\u0131n\u0131 ARC Kanser Destek Merkezi Dublin, \u0130rlanda\u2019da anektodal sonu\u00e7lar\u0131 g\u00f6sterir. Refleksoloji engellemeleri m\u00fc\u015fterilerin fiziksel ve psikolojik fonksiyonlar\u0131n\u0131 da i\u00e7eren zarar g\u00f6rme ve fonksiyonel durum seviyeleri \u00fczerinde olumlu olarak etkilemek i\u00e7in genel sa\u011fl\u0131k alg\u0131lar\u0131 gerektirmeleri ile hissedilmi\u015ftir. Bu belge bu bulgular\u0131n daha \u00f6tedekilerin temelini nas\u0131l olu\u015fturabilece\u011fini kanserli insanlar i\u00e7in refleksolojinin yararlar\u0131n\u0131n ARC Kanser Destek Merkezinde daha dikkatli de\u011ferlendirilmesini tart\u0131\u015f\u0131r. 2002 Elsevier Science Ltd. T\u00fcm haklar\u0131 korunur.<\/p>\n\n\n\n

G\u0130R\u0130\u015e<\/strong><\/p>\n\n\n\n

QoL fakt\u00f6rleri kanser bak\u0131m\u0131na olan holistik yakla\u015f\u0131m\u0131n uygunlu\u011funa hastalar, genel halk ve sa\u011fl\u0131k hizmetleri profesyonelleri aras\u0131nda bilin\u00e7lenmeyi artt\u0131r\u0131rken, ayr\u0131ca b\u00fct\u00fcnleyici tedaviler kanserli QoL hastalar\u0131 \u00fczerinde etkiyi ara\u015ft\u0131rmak i\u00e7in de\u011ferlendirmeyi gerekli oldu\u011fu da ayr\u0131ca onaylanm\u0131\u015ft\u0131r (Fallowfield 1995, Bell & Sikora 1996, Richardson 2000, Gambles et al. 2001). ARC (Bak\u0131mdan sonra, Ara\u015ft\u0131rma, Dan\u0131\u015fmanl\u0131k) Kanser Destek Merkezi Psikososyal engellemeler aral\u0131\u011f\u0131nda b\u00fct\u00fcnleyici tedavileri, e\u011fitici ve davran\u0131\u015fsal tedavi, dan\u0131\u015fmanl\u0131k ve grup deste\u011fini de i\u00e7erdi\u011fi gibi partnerlerini ve\/veya bak\u0131c\u0131lar\u0131n\u0131 i\u00e7eren Dublin, \u0130rlanda\u2019da kay\u0131tl\u0131 bulunan kar amac\u0131 g\u00fctmeyen bir yard\u0131m derne\u011fidir. G\u00f6r\u00fcnen makale ARC Kanser Destek Merkezinde ba\u015flang\u0131\u00e7ta, anektodal bulgular\u0131n genel tasla\u011f\u0131n\u0131 m\u00fc\u015fterilerin alg\u0131lar\u0131n\u0131 kendi QoL\u2019leri \u00fczerinde refleksolojinin yararlar\u0131yla ba\u011flant\u0131l\u0131 olarak sunar.<\/p>\n\n\n\n

KAYNAK TARAMASI<\/strong><\/p>\n\n\n\n

QoL\u2019i d\u00fczeltmek i\u00e7in psikososyal engelleme olarak b\u00fct\u00fcnletici tedavi<\/p>\n\n\n\n

Hem kanser te\u015fhisinin travmas\u0131 hemde z\u0131t fiziksel ve psikolojik semptomlar\u0131n hastal\u0131k deneyimi ve kanser tedavisi ile ba\u011flant\u0131l\u0131 \u00f6nceden tutmak ve hafifletmek i\u00e7in erken m\u00fcdahale i\u00e7in gereklilik konusunda bilin\u00e7lenme artm\u0131\u015ft\u0131r (Cella et al. 1990, Mermelstein & Lesko 1992, Munkres et al. 1992, Spiegel 1993, Burish & Redd 1994, Cordova et al. 1995, Ferrell 1995, Tjemsland et al. 1996, Holland 1999).  Hafif masaj, koku tedavisi, rahatlama ve refleksoloji gibi b\u00fct\u00fcnleyici tedavileri de i\u00e7eren psikososyal m\u00fcdahaleler geleneksel kanser tedavisi ile ili\u015fkili olarak sa\u011flanmas\u0131 rahatlama tepkisini y\u00fckselterek, duygusal deste\u011fi sa\u011flayarak ve duygusal kontrol\u00fc, hali ve psikolojik refah\u0131 artt\u0131rarak kanserli insanlar\u0131n korkular\u0131n\u0131 ve s\u0131k\u0131nt\u0131lar\u0131n\u0131 deneyimlemeyi azaltmas\u0131 i\u00e7in yard\u0131mc\u0131 olabilir(Benson 1976, Fallowfield 1995, Greer et al. 1992, Doan 1998, Penson 1998, Laffoy 1999, Hodgson 2000, Stephenson et al. 2000). B\u00fct\u00fcnleyici tedaviler kanser olan baz\u0131 hastalar\u0131n \u00f6nemli psikolojik ihtiya\u00e7lar\u0131n\u0131 yerine getirebilir(Downer et al. 1994). Bu m\u00fcdahaleler hastalara destek ve kabul sunar ve belirsizlik, korku, k\u0131zg\u0131nl\u0131k, kaybetme ve kanser deneyimiyle ilgili s\u0131k\u0131nt\u0131 duygular\u0131yla ba\u015fedebilmek ve itiraf edebilmek i\u00e7in belirti azalmas\u0131 ile yard\u0131mc\u0131 olabilir(Crowther 1991, Ferrell-Torry & Glick 1993, Downer et al. 1994, Sloman 1995, Bell & Sikora 1996, Trousdale 1996, Penson 1998, Hodgson 2000, Stephenson et al. 2000). Psikososyal destek kanser hastal\u0131\u011f\u0131na d\u00fczeltilmi\u015f psikolojik de\u011ferlendirme \u00fczerine olan \u00f6nemli etkisi g\u00f6sterilmi\u015ftir(Watson 1983, Dunkel-Schetter 1984, Dunkel-Schetter et al. 1992, Spiegel 1993, Arathuzik 1991a, 1991b, 1994). B\u00fct\u00fcnleyici tedaviler hayati tehlike olu\u015fturan hastal\u0131klarla kar\u015f\u0131 kar\u015f\u0131ya bulunan insanlar i\u00e7in daha fazla se\u00e7enek ve kontrol olana\u011f\u0131 sunar (Penson 1998) ve al\u0131nan bak\u0131m unsuru refah ve QoL duygusu i\u00e7in \u00f6nemli etkileri d\u00fczeltilebilir(Benner & Wruble 1989).<\/p>\n\n\n\n

\u0130Y\u0130LE\u015eT\u0130R\u0130C\u0130 M\u00dcDAHALE OLARAK REFLEKSOLOJ\u0130 \u0130\u00c7\u0130N GEREK\u00c7E<\/p>\n\n\n\n

Refleksoloji Teorisi<\/strong><\/p>\n\n\n\n

Refleksoloji, sinir ileti\u015fimini d\u00fczeltmek, fizyolojik fonksiyonu uyumla\u015ft\u0131rmak ve rahatlama cevab\u0131n\u0131 d\u00fczenlemek i\u00e7in tasarlanan ayak ve el bas\u0131n\u00e7 tedavi birle\u015fimidir(Crane 1997, Kuhn 1999, Stephenson et al. 2000). Refleksolojinin etkileri ile ilgili bir\u00e7ok teori vard\u0131r, bir proprioseptif teori olarak sinir al\u0131c\u0131lar\u0131, merkez ve \u00e7evresel sinir sistemlerinin ba\u015f\u0131ndan sonuna kadar ba\u011flant\u0131l\u0131 olman\u0131n \u00fczerinde durur(Stephenson et al. 2000). Refleks ark\u0131 bir dereceye kadar bilin\u00e7 kontrol\u00fc i\u00e7ermeyen basit sinir d\u00f6ng\u00fcs\u00fcd\u00fcr (Crane 1997). Refleksoloji uygulamas\u0131 eller ve ayaklar \u00fczerinde v\u00fccuttaki t\u00fcm kaslara, sinirlere, organlara, bezelere ve kemiklere kar\u015f\u0131l\u0131k gelen refleks noktalar\u0131 oldu\u011fu \u00f6nc\u00fcl\u00fcne dayan\u0131r (Crane 1997, Kuhn 1999, Hodgson 2000), ve bu refleks noktalar\u0131n\u0131 uyarmak i\u00e7in ellere ve\/veya ayaklara yumu\u015fak bas\u0131nc uygulamas\u0131n\u0131 i\u00e7erir(Crane 1997, Hodgson 2000). Hastal\u0131k fonksiyonda dengesizlik yarat\u0131rsa, sinir sinyali engellenebilir. Eller ve ayaklar \u00fczerindeki belirli noktalara yap\u0131lan bas\u0131n\u00e7 daha iyi kan ak\u0131\u015f\u0131na, sinir sinyalleri, toksinlerin ve endorfinlerin sal\u0131n\u0131m\u0131na katk\u0131da bulunmak i\u00e7in, geli\u015ftirilmi\u015f fonksiyonu ve refah\u0131 kolayla\u015ft\u0131rmak i\u00e7in nitelendirilir(Kuhn 1999). Refleksolojinin kullan\u0131m\u0131 rahatlama cevab\u0131nda ind\u00fcksiyona katk\u0131da bulunur ve sonu\u00e7 olarak korku azalmas\u0131nda etkisi olabilir(Crane 1997, Stephenson et al. 2000).<\/p>\n\n\n\n

\u00c7ALI\u015eMANIN AMACI<\/strong><\/p>\n\n\n\n

\u00c7al\u0131\u015fma m\u00fc\u015fterilerin alg\u0131lar\u0131n\u0131 refleksoloji m\u00fcdahalelerinden al\u0131nan yararlardan geriye d\u00f6n\u00fck bir \u015fekilde incelenmi\u015ftir:<\/p>\n\n\n\n

*M\u00fc\u015fterilerin alg\u0131lar\u0131n\u0131 onlar\u0131n QoL\u2019leri \u00fczerinden refleksoloji m\u00fcdahalelerinin yararlar\u0131n\u0131 tan\u0131mlar.<\/p>\n\n\n\n

*Refleksoloji m\u00fcdahalelerinin yararlar\u0131nda m\u00fc\u015fterilerin alg\u0131lar\u0131yla alakal\u0131 yayg\u0131n konular olup olmayaca\u011f\u0131n\u0131 tan\u0131mlar.<\/p>\n\n\n\n

*QoL\u2019in farkl\u0131 etki alanlar\u0131 \u00fczerinden al\u0131nan refleksoloji m\u00fcdahalelerinin etkisini belirler.<\/p>\n\n\n\n

Y\u00d6NTEMB\u0130L\u0130M<\/strong><\/p>\n\n\n\n

Refleksoloji \u00e7izelgeleri 1998\u2019de ARC Kanser Destek Merkezi\u2019nde m\u00fcdahalelerin ba\u015flang\u0131c\u0131nda terapistler taraf\u0131ndan korunur. T\u00fcm m\u00fc\u015fteriler haftal\u0131k aral\u0131klarla s\u00fcren refleksoloji tedavilerimdem \u00f6nce sa\u011fl\u0131k onay\u0131 al\u0131r. M\u00fc\u015fterilerin niteliksel, de\u011ferlendirici yorumlar\u0131 m\u00fcdahale s\u00fcrecinde s\u00fcrmekte olan temelde kaydedilmi\u015ftir. T\u00fcm kay\u0131tl\u0131 m\u00fcdahale bilgisi ki\u015fiye g\u00f6re de\u011fi\u015fir ve niteliklidir. M\u00fc\u015fterilerin tablolar\u0131ndan bir \u00f6rnek 2001 Nisan\u0131nda rastgele se\u00e7ilmi\u015f ve incelenmi\u015ftir. Tan\u0131mlay\u0131c\u0131 istatistikler g\u00f6stergeler ve QoL\u2019in etki alanlar\u0131na dayanarak refleksoloji m\u00fcdahalelerinin yararlar\u0131nda m\u00fc\u015fterilerin alg\u0131lar\u0131n\u0131 s\u0131n\u0131fland\u0131rmak i\u00e7in de\u011ferlendirilmi\u015ftir (Patrick & Ericson 1993). Tablo 1 ARC Kanser Destek Merkezinde refleksoloji m\u00fcdahalelerini alan m\u00fc\u015fterilerin \u00e7o\u011funlu\u011fu ya\u015flar\u0131 40 ile 69 aras\u0131nda de\u011fi\u015fen ve ilk g\u00f6\u011f\u00fcs kanseri ile te\u015fhis edilen kad\u0131nlard\u0131r. Kanserin seviyesi m\u00fc\u015fterilerin \u00e7izelgelerinde belirtilmemesine ra\u011fmen baz\u0131 m\u00fc\u015fterilerin ikincil kanseri vard\u0131r. M\u00fc\u015fterilerin \u00e7o\u011funlu\u011fu ya kanser tedavisini, \u0131\u015f\u0131n tedavisini ya da her ikisinin birle\u015fimini al\u0131yor ya da alm\u0131\u015ft\u0131r.<\/p>\n\n\n\n

Tablo 2\u2019de g\u00f6sterilmi\u015f olan QoL\u2019in yararlar\u0131 m\u00fc\u015fterilerin \u00e7izelgelerinde hem tedavi s\u00fcreci sonunda hem de a\u015fa\u011f\u0131daki bireysel refleksoloji tedavi b\u00f6l\u00fcmlerinde kaydedilmi\u015ftir. M\u00fc\u015fteriler iki QoL g\u00f6stergesiyle (fonksiyonel durum ve bozulma) ilgili olarak a\u015fa\u011f\u0131daki refleksoloji m\u00fcdahalelerindeki ilerlemeleri rapor etmi\u015ftir(Patrick & Ericson 1993). M\u00fc\u015fterilerin alg\u0131lad\u0131klar\u0131 yararlar\u0131 bu iki QoL kavram\u0131n\u0131 kendi alakal\u0131 etkinlik alan\u0131yla ba\u011flant\u0131l\u0131 olarak s\u0131n\u0131fland\u0131r\u0131labilir. Fonksiyonel durumu hem d\u00fczeltilmi\u015f fiziksel fonksiyonu (\u00f6rne\u011fin uyku ve azalan enerji) ve psikolojik fonksiyon (\u00f6rne\u011fin rahatlama, kendiyle ba\u015fa \u00e7\u0131kman\u0131n geli\u015fmi\u015f hissi ve gerilmede azalma)y\u0131 kapsarken bozulma a\u011fr\u0131 gidermeye g\u00fcc\u00fc yetmesi ve d\u00fczeltilmi\u015f v\u00fccut fonksiyonu gibi deneyimlenen semptomlarda ve \u00f6znel \u015fik\u00e2yetlerde de\u011fi\u015fiklikleri kapsar. Bu geni\u015f kapsaml\u0131 ilerlemeler iyile\u015ftirilmi\u015f sa\u011fl\u0131k alg\u0131s\u0131nda \u00fc\u00e7\u00fcnc\u00fc QoL kavram\u0131na katk\u0131da bulunur (Patrick & Erickson 1993, Ferrell et al. 1995).<\/p>\n\n\n\n

Psikolojik fonksiyona dayanarak Tablo 2 m\u00fc\u015fterilerin %34\u2019\u00fcn\u00fcn rahatlama duyusunu rapor etmi\u015f, %6,4\u2019\u00fc gerilmede azalma ve ilerlemi\u015f \u00fcstesinden gelme hissini deneyimlemi\u015flerken m\u00fc\u015fterilerin %29,8\u2019i benlik duygusu (\u2018iyi\u2019, daha olumlu ve d\u00fczelmi\u015f refah olarak tan\u0131mlan\u0131r) geli\u015ftirilmi\u015f oldu\u011funu rapor ettiklerini g\u00f6sterir. Fiziksel fonksiyondaki d\u00fczelmelere dayanarak, m\u00fc\u015fterilerin %29,8\u2019i uyku d\u00fczenindeki ilerlemeyi ve %27,6\u2019s\u0131 da enerji seviyelerindeki art\u0131\u015f\u0131 rapor etmi\u015flerdir. Tablo 2 ayr\u0131ca m\u00fc\u015fterilerin %23\u2019\u00fcn\u00fcn refleksoloji m\u00fcdahalelerinin deneyimlenen a\u011fr\u0131 inanc\u0131ndan sa\u011flad\u0131\u011f\u0131n\u0131 nitelendirmi\u015fken, m\u00fc\u015fterilerin %27,7\u2019si refleksolojinin ilerlemi\u015f v\u00fccut fonksiyonlar\u0131na katk\u0131 sa\u011flad\u0131\u011f\u0131n\u0131 dikkate alm\u0131\u015flard\u0131r. Refleksolojinin yararlar\u0131n\u0131nda m\u00fc\u015fterilerin \u00f6znel de\u011ferlendirmelerinin \u00f6rne\u011fi hem refleksoloji tedavisi s\u0131ras\u0131nda hemde a\u015fa\u011f\u0131daki b\u00f6l\u00fcmde not edilip Kutu 1\u2019de g\u00f6sterilmi\u015ftir.<\/p>\n\n\n\n

TARTI\u015eMA<\/strong><\/p>\n\n\n\n

Refleksoloji ve QoL g\u00f6stergelerinin etkile\u015fimi<\/p>\n\n\n\n

Sa\u011fl\u0131k kavram\u0131ndaki QoL ki\u015filer taraf\u0131ndan tahsis edilmi\u015f de\u011fer olarak (1)fonksiyonel durum, (2)bozulmalar, (3)sa\u011fl\u0131k anlay\u0131\u015f\u0131, (4)f\u0131rsatlar ve (5) \u00f6l\u00fcm ve hayat s\u00fcreci hastal\u0131\u011f\u0131n, yaralanman\u0131n, tedavinin ya da prensiplerin etkisine arac\u0131l\u0131\u011f\u0131yla de\u011fi\u015ftirilmi\u015ftir. QoL\u2019in be\u015f g\u00f6stergesi tav\u0131rlar, davran\u0131\u015flar, alg\u0131lar ve eylemin ve d\u00fc\u015f\u00fcncenin alan\u0131ndaki etkinlik alanlar\u0131na b\u00f6l\u00fcnebilir (Patrick & Ericson 1993). Kanser hastalar\u0131 i\u00e7im olan QoL etkinlik alanlar\u0131 fiziksel, psikolojik, sosyal ve ruhsal refah\u0131 i\u00e7erir(Fallowfield 1990, Ferrell et al. 1995). Farkl\u0131 kavramlar ve etkinlik alanlar\u0131 sa\u011fl\u0131k durumunu s\u0131n\u0131fland\u0131rmada etkile\u015fim i\u00e7inde olabilmesine ra\u011fmen (Patrick & Erickson 1993) ayn\u0131 etkile\u015fim bireysel QoL i\u00e7in i\u00e7erir. \u00d6rne\u011fin, \u00e7al\u0131\u015fmam\u0131zda d\u00fczeltilmi\u015f fiziksel fonksiyon ve azalt\u0131lm\u0131\u015f a\u011fr\u0131 deneyimi refleksoloji tedavilerini izleyerek (Tablo 2) m\u00fc\u015fterilerin alg\u0131lar\u0131 geli\u015fmi\u015f benlik duygusuna (daha fazla refah ve daha olumlu hissetmek gibi tan\u0131mlanabilir) refleksoloji m\u00fcdahalelerine olan bu QoL ilerlemelerine katk\u0131 sa\u011flayan m\u00fc\u015fterilerin %29,8\u2019inin deneyimledi\u011fi gibidir.<\/p>\n\n\n\n

Fonksiyonel durumda refleksolojinin olas\u0131 yararlar\u0131 ve kanser hastalar\u0131nda azalma<\/strong><\/p>\n\n\n\n

Sa\u011fl\u0131kla ilgili QoL\u2019de daha k\u00fc\u00e7\u00fck semptomlar fizyolojik ya da sosyal fonksiyonuna zarar veremezken, b\u00fcy\u00fck eksiklikler ve semptomlar b\u00fcy\u00fck psikolojik ve sosyal i\u015flev bozuklu\u011funa neden olabilir (Patrick & Erickson 1993). Kanserle ba\u011flant\u0131l\u0131 olan semptomlar\u0131n pek \u00e7o\u011fu ki\u015finin a\u011fr\u0131 deneyimini k\u00f6t\u00fcle\u015ftirebilir, biti\u015fik yap\u0131lar\u0131n metastatik sald\u0131r\u0131s\u0131 da olabilir (Twycross 1994, Buckman 1996, Parris 1997). Otonom ve somatosensori reaktivitesi i\u00e7in a\u011fr\u0131 gerilme d\u00f6ng\u00fcs\u00fc taraf\u0131ndan korunan ve \u015fiddetlendirilen a\u011fr\u0131ya ko\u015fulland\u0131r\u0131lm\u0131\u015f cevab\u0131n\u0131 verebilmesi i\u00e7in olas\u0131d\u0131r(Evers et al. 2001). \u0130lerlemi\u015f a\u011fr\u0131yla ilgili olan \u00e7o\u011funlukla duygu korkudur(Sternbach 1976). Hastan\u0131n korkular\u0131yla alakal\u0131 olan kavramdaki uyar\u0131lm\u0131\u015f korku, \u00f6rne\u011fin, t\u0131bbi prosed\u00fcrler hakk\u0131nda korku, a\u011fr\u0131n\u0131n daha \u00e7ok alg\u0131lanmas\u0131yla sonu\u00e7lan\u0131r (Breitbart et al. 1997). Bununla birlikte, kanser a\u011fr\u0131s\u0131n\u0131 hafifleten somatik olarak d\u00fczenlenmi\u015f m\u00fcdahaleler psikolojik rahats\u0131zl\u0131\u011f\u0131 azaltmak i\u00e7in de g\u00f6sterilirken, duygusal s\u0131k\u0131nt\u0131y\u0131 rahatlatmay\u0131 ama\u00e7layan psikososyal m\u00fcdahaleler nosisepsiyon \u00fczerinde b\u00fcy\u00fck bir etkisi vard\u0131r (Breitbart et al. 1997). Kanser hastalar\u0131 \u00e7o\u011funlukla korku ve bunal\u0131m\u0131, ciddi rahats\u0131zl\u0131\u011f\u0131 tecr\u00fcbe eder(Watson 1991, Breitbart et al. 1997, Passik et al. 1997). \u00c7al\u0131\u015fmalar korku ve bunal\u0131m\u0131n a\u011fr\u0131 deneyiminde azalma ile olas\u0131 a\u011fr\u0131 a\u015famas\u0131yla artarak ba\u011flant\u0131l\u0131 oldu\u011funu g\u00f6sterir (O\u2019Boyle et al. 1988). Tutumun ve halin semptomlar\u0131n yo\u011funlu\u011fu \u00fczerinde d\u00f6ng\u00fcsel etkisi olabilir (Peteet et al. 1986).<\/p>\n\n\n\n

Bu \u00e7al\u0131\u015fma kapsam\u0131nda, korku ve gerilmedeki azalma, refleksoloji m\u00fcdahalesini izleyen rahatlama durumu ile birlikte deneyimlenmesi a\u011fr\u0131-korku-gerilme d\u00f6ng\u00fcs\u00fc \u00fczerinde etkisi olur (Sloman 1995) m\u00fc\u015fterilerin %23\u2019\u00fc refleksoloji tedavisini izleyen a\u011fr\u0131y\u0131 deneyimlediklerini s\u00f6ylerken, m\u00fc\u015fterilerin %34\u2019\u00fc rahatlama ile kar\u015f\u0131la\u015ft\u0131klar\u0131n\u0131, %29,8\u2019i uykular\u0131n\u0131n d\u00fczeldi\u011fini, m\u00fc\u015fterilerin %27,6\u2019s\u0131 enerjilerinin artt\u0131\u011f\u0131n\u0131 ve %27,7\u2019si de v\u00fccut fonksiyonlar\u0131n\u0131n d\u00fczeldi\u011fini belirtmi\u015ftir (Tablo 2). Bu anektosdal bulgular kaynaklardaki bulgularla birbirini tutar. Stephenson ve di\u011ferleri (2000) taraf\u0131ndan yap\u0131lan \u00e7al\u0131\u015fmada ayak refleksolojisinin korku ve a\u011fr\u0131 \u00fczerinde olan etkileri kanser g\u00f6\u011f\u00fcs ve akci\u011fer kanseri olan hastalarda sanki kendi kontrollerindeymi\u015f gibi davran\u0131rken korku de\u011ferleri \u00f6nemli bir \u015fekilde ayak refleksolojisinden sonra daha d\u00fc\u015f\u00fck \u00e7\u0131km\u0131\u015ft\u0131r. Hodgson (2000) taraf\u0131ndan yap\u0131lan \u00e7al\u0131\u015fmada kanser i\u00e7in hafifletici bak\u0131m alan hastalar\u0131n QoL \u00fczerinde refleksoloji m\u00fcdahalelerinin etkisi refleksoloji grubu ve plasebo alan grup aras\u0131nda \u00f6nemli farkl\u0131l\u0131k bulmu\u015ftur, \u00f6nceki grup sonrakinden daha \u00e7ok yarar sa\u011flam\u0131\u015ft\u0131r. Coxon (1998) taraf\u0131ndan yap\u0131lan nitelikli \u00e7al\u0131\u015fmada m\u00fc\u015fterilerin refleksoloji m\u00fcdahalelerinden semptomlar i\u00e7in ald\u0131klar\u0131 yararlar hem migren, ba\u015f a\u011fr\u0131lar\u0131, s\u0131rt a\u011fr\u0131s\u0131, kronik yorgunluk ve\/veya romatizma \u201cg\u00f6stermi\u015ftir ki cevap niteli\u011findeki her hissedilen genellikle nas\u0131l hissettiklerini refleksolojinin nas\u0131l bir etki yapt\u0131\u011f\u0131n\u0131 d\u00fczenli al\u0131nan a\u011fr\u0131lar ve d\u00fczenl, ba\u015f etme , azalan yorgunluk ve rahatlaman\u0131n daha \u00e7ok hissiyat\u0131 ile belirlenmi\u015f yararlar\u0131n\u0131 getirir. Trousdeell (1996) taraf\u0131ndan yap\u0131lan nitelikli \u00e7al\u0131\u015fma refleksolojinin stres seviyelerini ve semptomlar\u0131 azaltmada ve m\u00fccadelede ruhsal sa\u011fl\u0131k problemleri olan bir grup kad\u0131n i\u00e7in refah hissinin artt\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir.<\/p>\n\n\n\n

T\u00fcm\u00f6r ve a\u011fr\u0131 kontrol\u00fc geleneksel kanser tedavisinde \u00f6ncelikli ama\u00e7 iken, bu gidi tedavilerin yan etkileri yorgunluk, a\u011fr\u0131, nefes darl\u0131\u011f\u0131, fiziksel bozulma, cinsel ve mahremiyet konular\u0131 ve bili\u015fsel bozulmalardan herhangi biri kanserden sa\u011f kalanlar\u0131n fiziksel rahatl\u0131\u011f\u0131n\u0131 t\u00fcketebilir (Ferrell et al. 1995). G\u00fcncel \u00e7al\u0131\u015fman\u0131n i\u00e7eri\u011finde, hastalar geleneksel kanser tedavisinden olas\u0131 yan etkileri deneyimleyebilirler (Oberst et al. 1991, Munkres et al. 1992). Bu yan etkilerin refleksoloji tedavileri tamamland\u0131k\u00e7a azalabilece\u011fi olas\u0131d\u0131r. M\u00fc\u015fteriler refleksoloji terapistlerine kanser tedavilerini izleyen \u2018iyi ve k\u00f6t\u00fc\u2019 g\u00fcnlerin fark\u0131nda olduklar\u0131n\u0131 ve refleksoloji tedavilerinin k\u00f6t\u00fc g\u00fcnlerin sonu\u00e7lar\u0131n\u0131 de\u011fi\u015ftirecek izlenimini verdi\u011fi \u015feklinde yorumlam\u0131\u015flard\u0131r.<\/p>\n\n\n\n

Biyopsikososyal model ve QoL\u2019in i\u00e7eri\u011findeki Refleksoloji<\/strong><\/p>\n\n\n\n

Kanser ve ilgili tedavilerin deneyimlenmesi tehlike, zarar ve\/veya hasar\u0131 i\u00e7eren stresli de\u011ferlendirmeler \u00fcretebilir (Lazarus & Folkman 1984). Bu gibi de\u011ferlendirmeler hali do\u011frudan etkileyebilir ve durumu \u00fczerinde semptom endi\u015fesinin etkilerine arac\u0131l\u0131k eder. QoL g\u00f6stergeleri ve etkinlik alanlar\u0131n\u0131n olas\u0131 etkile\u015fimi (\u00f6rne\u011fin, psikolojik refah \u00fczerinde d\u00fczeltilmi\u015f fiziksel fonksiyonun etkisi) s\u00fcrmekte olan anektodal \u00e7al\u0131\u015fma ile ilgili olarak biyolojik, psikolojik ve sosyal de\u011fi\u015fkenlerin karma\u015f\u0131k etkile\u015fiminin sonucu olarak hastal\u0131k \u00fczerindeki biyopsikososyal modele odaklanarak g\u00f6sterir. Hastal\u0131k \u2018\u00f6znel deneyim yada kendine y\u00fckleme olarak tan\u0131mlanabilirken hasta insan ve onun ailesinin \u00fcyeler, ve daha geni\u015f sosyal a\u011f\u0131 nas\u0131l al\u0131r, birlikte ya\u015far ve semptomlara ve yetersizli\u011fe cevap verece\u011fi ile ilgilidir (Waddell 1992, Fordyce 1995, Turk 1996). \u0130nsanlar\u0131n a\u011fr\u0131ya ba\u015flang\u0131\u00e7ta semptomlara tepkileri ve ko\u015ful devam ettik\u00e7e cevaplar\u0131n nas\u0131l de\u011fi\u015fece\u011fi olduk\u00e7a \u00e7ok de\u011fi\u015fiklik g\u00f6sterir. A\u011fr\u0131 ve QoL\u2019in i\u00e7erikleri \u00e7ok ilgili oldu\u011fu varsay\u0131ld\u0131\u011f\u0131 i\u00e7in, bu ili\u015fkinin do\u011fas\u0131 sadece ge\u00e7enlerde tamamen kabul edilmi\u015ftir(Skevington 1995). Bu \u00e7al\u0131\u015fmayla ilgili anektodal bulgular m\u00fc\u015fterilerin fonksiyonel durumunun olas\u0131 etkile\u015fimini ve bozulma durumunu g\u00f6sterir, bu sayede rahatlamak i\u00e7in beceri artar, a\u011fr\u0131 deneyimi azal\u0131r, uyku d\u00fczelir ve d\u00fczelmi\u015f v\u00fccut fonksiyonlar\u0131 m\u00fc\u015fterilerin ba\u015f etme yetene\u011fini ve benlik alg\u0131s\u0131 geli\u015ftirilmi\u015f olabilir (Tablo 2).<\/p>\n\n\n\n

Refleksolojinin ba\u015f etme ve \u00f6z yeterlilik \u00fczerindeki alg\u0131lanan etkisi<\/strong><\/p>\n\n\n\n

Kanser hastalar\u0131 kendi korkular\u0131n\u0131 ve a\u011fr\u0131lar\u0131n\u0131 kronik problem olarak y\u00f6netmelidir (Stephenson et al. 2000). Kanser sadece hastalar\u0131n fiziksel sa\u011fl\u0131\u011f\u0131n\u0131 de\u011fil ayn\u0131 zamanda onlar\u0131n duygusal refah\u0131n\u0131 da tehdit eder (Jarrett et al. 1992). Kanser hastalar\u0131n\u0131n \u00e7o\u011funlu\u011funun yan\u0131tlarla ba\u015fa \u00e7\u0131kman\u0131n geni\u015f repertuar\u0131n\u0131 kullan\u0131ld\u0131\u011f\u0131 g\u00f6sterilir (Jarrett et al. 1992). Bu \u00e7al\u0131\u015fmada refleksoloji m\u00fcdahaleleri izler, m\u00fc\u015fterilerin %29.8\u2019i benlik duygusunu geli\u015ftirmi\u015f oldu\u011funu rapor etmi\u015ftir, \u2018b\u00fcy\u00fck refah duygusu\u2019 olarak tan\u0131mlan\u0131r ve \u2018daha olumlu\u2019 hissedilirken m\u00fc\u015fterilerin %6.4\u2019\u00fc d\u00fczeltilmi\u015f ba\u015f etmeyi raporlam\u0131\u015ft\u0131r (Tablo2). Bu bulgular tekrar QoL g\u00f6stergeleri ve etkile\u015fim alanlar\u0131n\u0131n olas\u0131 etkile\u015fimli etkilerini g\u00f6sterir (Patrick & Ericson 1993). G\u00fcnl\u00fck rutinleri ve konular\u0131n uygulanma kapasitesi ki\u015fisel ba\u011f\u0131ms\u0131zl\u0131\u011fa karar verir (Patrick & Erickson 1993), \u00f6z yeterlilik duygusunun, \u00fcst\u00fcnl\u00fc\u011f\u00fcn ve g\u00fcvenin esas belirleyicisidir (Bandura 1977, Schwarzer 1992). \u00d6z yeterlilik, ki\u015fisel becerideki inan\u00e7 se\u00e7ilen ba\u015f edilecek davran\u0131\u015flar\u0131 etkiler. Kar\u015f\u0131l\u0131k olarak, ba\u015f etme davran\u0131\u015f\u0131n\u0131n olas\u0131 sonucu \u00f6z yeterlili\u011fi geri bildirimin bilme ve davran\u0131\u015f aras\u0131nda s\u00fcrekli d\u00f6ng\u00fcs\u00fc etkiler (Zamble & Gekoski 1994). \u00c7al\u0131\u015fmalar \u00f6z yeterlilikteki inan\u00e7lar\u0131 sa\u011fl\u0131\u011f\u0131 tehdit eden olaylar ile ba\u015f etme durumunda daha aktif olmas\u0131 i\u00e7in ba\u011flant\u0131 kurar (Pearlin & Schooler 1978, Strickland 1978). Rahatlama cevab\u0131 korkuya kar\u015f\u0131 \u00e7\u0131kand\u0131r (Benson 1976, Arathusik 1994, Sloman 1995, Stephenson et al. 2000) ve ara\u015ft\u0131rma kas gerilimi, otonom hyperarousal, korku ve a\u011fr\u0131 aras\u0131nda ili\u015fki moldu\u011funu g\u00f6stermi\u015ftir (\u00f6rne\u011fin Fishman & Loscales 1987). Potansiyel olarak tehditkar olaylar \u00fczerinde kontrol uygulamas\u0131ndaki alg\u0131lanan \u00f6z yeterlilik korku uyar\u0131lmas\u0131 ve azalmas\u0131nda merkez rol\u00fcn\u00fc oynar (Bandura 1986). Refleksoloji m\u00fcdahalelerinin alg\u0131lanan yararlar\u0131 (Tablo 2) ayr\u0131nt\u0131l\u0131 olarak m\u00fc\u015fterilerin refah\u0131 \u00fczerine, olaylar\u0131n alg\u0131lanmas\u0131, m\u00fc\u015fterilerin ba\u015f etme becerisi ve \u00f6z yeterlilik duygular\u0131 tesir etmi\u015fken(Bandura 1977, Pearlin & Schooler 1978, Schwarzer 1992), Kutu 1\u2019de g\u00f6sterilen yorumlar ki\u015fisel QoL \u00fczerinde m\u00fc\u015fterilerin ilerleme duygular\u0131n\u0131n \u00f6znel geli\u015fimi g\u00f6sterilmi\u015ftir.<\/p>\n\n\n\n

Bulgulardan geli\u015ftirilen ileriki \u00e7al\u0131\u015fma tasar\u0131m\u0131<\/strong><\/p>\n\n\n\n

Burada tan\u0131mlanan anektodal bulgular kanser hastalar\u0131 i\u00e7in refleksolojinin yararlar\u0131n\u0131n anla\u015f\u0131lmas\u0131n\u0131 destekler ve daha detayl\u0131 ve kontroll\u00fc ara\u015ft\u0131rma \u00e7al\u0131\u015fmas\u0131 i\u00e7in alanlar\u0131 tan\u0131mlar (Mackereth et al. 2000). Bununla birlikte, \u00e7al\u0131\u015fma tasar\u0131mlar\u0131n\u0131n tamamlay\u0131c\u0131 tedavilerin geli\u015fimi i\u00e7in se\u00e7imi karma\u015f\u0131k konu olarak tan\u0131mlanabilir. Esas d\u00fc\u015f\u00fcnceler Liverani ve di\u011ferleri (2000) taraf\u0131ndan \u00f6zellikle \u00e7ift-k\u00f6r\u00fcn kullan\u0131m\u0131 hakk\u0131nda dikkate alma, plaseboya kar\u015f\u0131 kontroll\u00fc \u00e7al\u0131\u015fmalar, rastgellenmi\u015f Kontroll\u00fc Deneme (RCT) bak\u0131m\u0131ndan bu gibi de\u011ferlendirmeler i\u00e7in \u00f6zetlenmi\u015ftir. Geleneksel dirimsel t\u0131bb\u0131n oldu\u011fu \u00fclkelerde D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fcn\u00fcn sa\u011fl\u0131k s\u00fcrecinin temelinde olan alopatik olmayan t\u0131plar\u0131n etkinli\u011fini belirlemek i\u00e7in gerekli kontroll\u00fc denemeleri belirtir. Bu konu iki ana durumda sonu\u00e7lan\u0131r. \u0130lk durum baz\u0131 tip ara\u015ft\u0131rmalar\u0131n tavsiye veren ve y\u00f6netmelik \u00fcreten Tamamlay\u0131c\u0131 ve Alternatif T\u0131p \u00fczerindeki ara\u015ft\u0131rmada Nicel Metodlarda \u00c7al\u0131\u015fma Grubunun Metodolojik Manifesti taraf\u0131ndan t\u0131p ara\u015ft\u0131rma ola\u011fan prosed\u00fcrleri uygun olmayabilir ve belirli problemlere uygulanan istatiksel yakla\u015f\u0131mlar ve farkl\u0131 metodolojiler gerektirebilir. Liverani ve di\u011ferleri (2000) RCTlerin tedavileri de\u011ferlendirmede hastal\u0131\u011f\u0131n ilerlemi\u015f a\u015famalar\u0131nda kolayca tan\u0131mlanan biti\u015f noktalar\u0131yla etkili oldu\u011funu ve RCTlerin alt\u0131nda yatan felsefe \u00f6znel deneyimin ba\u011fl\u0131l\u0131\u011f\u0131n\u0131 dikkate almad\u0131\u011f\u0131n\u0131 belirtir. Bununla birlikte, klasik RCT paradigman\u0131n uygulanmas\u0131n\u0131n tamamlay\u0131c\u0131 tedavilerde de\u011ferlendirilmesine uygunlu\u011fu soru olabilirken, t\u00fcm psikososyal yakla\u015f\u0131m m\u00fcdahalelerinin kan\u0131t bazl\u0131 de\u011ferlendirilmesi i\u00e7in tamamlay\u0131c\u0131 tedavilerden \u015f\u00fche etmeden gerekliliktir. Bu gibi de\u011ferlendirmeler belirli kanser hastalar\u0131n\u0131 i\u00e7erir, prognostik de\u011fi\u015fkenlerin temelinde m\u00fcdahale ve sonu\u00e7 \u00f6l\u00e7\u00fcmlerinin a\u00e7\u0131k y\u00f6netimi ile katmanla\u015fm\u0131\u015ft\u0131r (Spiegel 1993). Kanser hastalar\u0131 genellikle umutla ve semptom kontrol ve refahla alakal\u0131 QoL\u2019in a\u00e7\u0131s\u0131ndaki ilerlemelerin beklentisi tamamlay\u0131c\u0131 tedavileri y\u00fcklenir. Bu ba\u011flamda (durum iki) WHO geleneksel m\u00fcdahalelerin ve tamamlay\u0131c\u0131 tedavilerin etkisini hastal\u0131ktan \u00f6te ki\u015filerin QoL\u2019i \u00fczerinde de\u011ferlendirmek i\u00e7in yarat\u0131lm\u0131\u015ft\u0131r (WHOQOL Grup 1995, Liverani ve di\u011ferlerinden al\u0131nt\u0131 yap\u0131lm\u0131\u015ft\u0131r (2000)). Nitelikli ve nicel metodolojilerin birle\u015fimi QoL etkinlik alanlar\u0131na uygulanan de\u011ferlendirilmesi g\u00fc\u00e7l\u00fckle ili\u015fkilendirilmi\u015f baz\u0131 zorluklar\u0131n kararl\u0131l\u0131\u011f\u0131na katk\u0131da bulunabilir.<\/p>\n\n\n\n

Tamamlay\u0131c\u0131 tedavilerin de\u011ferlendirilmesinde plasebo etkinin varl\u0131\u011f\u0131 \u00e7o\u011funlukla sorgulanm\u0131\u015ft\u0131r (Skevington 1995). \u00d6zellikle, sebepler rastgele deneysel ya da kontrol gruplar\u0131na g\u00f6revlendirildi\u011fi zaman bile tamamen kontrol edilemeyen \u2018plasebo etkileri\u2019 problemleri do\u011furur. M\u00fcmk\u00fcn oldu\u011funda, tamamlay\u0131c\u0131 tedavilerde farkl\u0131 tedavilerin de\u011ferlendirilmesindeki kar\u015f\u0131la\u015ft\u0131rman\u0131n kullan\u0131m\u0131 ya da hastalar\u0131n kendi kontrollerindeymi\u015f gibi davranmalar\u0131 gibi RCT\u2019nin yar\u0131-deneysel metodlara adaptasyonu plasebo etkileri ile ilgili baz\u0131 problemlerin \u00fcstesinden gelmeye yard\u0131mc\u0131 olabilir.<\/p>\n\n\n\n

SONU\u00c7<\/strong><\/p>\n\n\n\n

Kanser hastalar\u0131n\u0131n psikososyal m\u00fcdahalelerinin \u00f6nemi olu\u015fur \u00e7\u00fcnk\u00fc (1) hem hastal\u0131k hemde kanser tedavisinin yan etkileri ile ilgili semptomlar\u0131n yo\u011funlu\u011funun tan\u0131mlanmas\u0131 ve (2)en uygun fonksiyonun kolayla\u015ft\u0131rmas\u0131 i\u00e7in gereklilik ve s\u00fcregelen hastal\u0131k deneyimi ve\/veya ilgili tedavi ki\u015fi i\u00e7in hayat tatminidir. Geleneksel t\u0131p m\u00fcdahaleleri yaln\u0131zca \u00e7o\u011funlukla QoL gerekliliklerini bu hasta pop\u00fclasyonunda kar\u015f\u0131lamaz, sonu\u00e7 olarak tamamlay\u0131c\u0131 tedaviler, kanser hastalar\u0131n\u0131n QoLi artt\u0131ran di\u011fer psikososyal m\u00fcdahalelerle birlikte d\u00fc\u015f\u00fcn\u00fclmesi gerekir (Watson 1983, Spiegel 1993, Fallowfield 1995, Hodgson 2000). Refleksoloji geni\u015f aral\u0131kta ko\u015fullarda insanlar\u0131n tedavi edilmesi i\u00e7in kullan\u0131l\u0131r ve refleksolojinin yararlar\u0131n\u0131 de\u011ferlendiren kaynaklar\u0131n \u00e7o\u011fu anektodald\u0131r. QoL\u2019in \u00e7e\u015fitli etkinlik yerlerinde \u00e7ok kapsaml\u0131 hastal\u0131klarla kanser de d\u00e2hil olmak \u00fczere insanlar i\u00e7in alg\u0131lanan ilerlemelerin anahatlar\u0131n\u0131 belirleyen \u00e7ok say\u0131da rapor varken daha dikkatli de\u011ferlendirme bilgiye dayanan deneyimlere izin vermesi ve kanser hastalar\u0131 i\u00e7in refleksoloji m\u00fcdahalelerinin kullan\u0131m\u0131 ayarlamak i\u00e7in \u00f6nemlidir (Botting 1997). Burada g\u00f6sterilen bir grup kanser hastas\u0131 i\u00e7in refleksolojinin yararlar\u0131n\u0131n anektodal bulgular\u0131 ilerisi i\u00e7in rehber olabilir, ara\u015ft\u0131rma tabanl\u0131 \u00f6zellikle tasarlanan\u0131n kullan\u0131m\u0131 ve \u00f6l\u00e7\u00fcm arac\u0131n\u0131n onaylanmas\u0131 ile ve dikkatlice d\u00fc\u015f\u00fcn\u00fclm\u00fc\u015ft\u00fcr ve ara\u015ft\u0131rma tasar\u0131m\u0131 uygundur.<\/p>\n","protected":false},"excerpt":{"rendered":"

Yrd. Do\u00e7. Dr. Mustafa YA\u011eBASAN Sa\u011fl\u0131k hizmetleri profesyonelleri, hastalar ve kanser bak\u0131m\u0131na olan holistik yakla\u015f\u0131m\u0131n \u00f6neminde genel halk aras\u0131nda bilin\u00e7lilik artm\u0131\u015ft\u0131r. B\u00fct\u00fcnleyici tedavileri de i\u00e7eren psikososyal engellemeler kanserli insanlar\u0131n hayat kalitesini (QoL) d\u00fczeltmek i\u00e7in te\u015fhisle ba\u011flant\u0131l\u0131 olarak s\u0131k\u0131nt\u0131y\u0131 azalmaya yard\u0131mc\u0131 olarak ve d\u00fczeltilmi\u015f psikolojik ayarlama kanser deneyimini kolayla\u015ft\u0131rarak yard\u0131mc\u0131 olabilir. A\u015fa\u011f\u0131daki makale kendi QoL\u2019lerinde ya\u015fam […]<\/p>\n","protected":false},"author":1,"featured_media":5350,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[190],"tags":[],"class_list":["post-5277","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-bilimsel-makaleler"],"featured_image_src":{"landsacpe":["https:\/\/bcuni.eu\/tr\/wp-content\/uploads\/2021\/10\/DOKTOR-HASTA-ILISKISI-VE-ILETISIMSEL-SORUNLAR-1.jpg",570,265,false],"list":["https:\/\/bcuni.eu\/tr\/wp-content\/uploads\/2021\/10\/DOKTOR-HASTA-ILISKISI-VE-ILETISIMSEL-SORUNLAR-1-463x265.jpg",463,265,true],"medium":["https:\/\/bcuni.eu\/tr\/wp-content\/uploads\/2021\/10\/DOKTOR-HASTA-ILISKISI-VE-ILETISIMSEL-SORUNLAR-1-300x139.jpg",300,139,true],"full":["https:\/\/bcuni.eu\/tr\/wp-content\/uploads\/2021\/10\/DOKTOR-HASTA-ILISKISI-VE-ILETISIMSEL-SORUNLAR-1.jpg",570,265,false]},"yoast_head":"\nDOKTOR-HASTA \u0130L\u0130\u015eK\u0130S\u0130 VE \u0130LET\u0130\u015e\u0130MSEL SORUNLAR - Brussels Capital University<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/bcuni.eu\/tr\/doktor-hasta-iliskisi-ve-iletisimsel-sorunlar\/\" \/>\n<meta property=\"og:locale\" content=\"tr_TR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"DOKTOR-HASTA \u0130L\u0130\u015eK\u0130S\u0130 VE \u0130LET\u0130\u015e\u0130MSEL SORUNLAR - Brussels Capital University\" \/>\n<meta property=\"og:description\" content=\"Yrd. 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Do\u00e7. Dr. Mustafa YA\u011eBASAN Sa\u011fl\u0131k hizmetleri profesyonelleri, hastalar ve kanser bak\u0131m\u0131na olan holistik yakla\u015f\u0131m\u0131n \u00f6neminde genel halk aras\u0131nda bilin\u00e7lilik artm\u0131\u015ft\u0131r. B\u00fct\u00fcnleyici tedavileri de i\u00e7eren psikososyal engellemeler kanserli insanlar\u0131n hayat kalitesini (QoL) d\u00fczeltmek i\u00e7in te\u015fhisle ba\u011flant\u0131l\u0131 olarak s\u0131k\u0131nt\u0131y\u0131 azalmaya yard\u0131mc\u0131 olarak ve d\u00fczeltilmi\u015f psikolojik ayarlama kanser deneyimini kolayla\u015ft\u0131rarak yard\u0131mc\u0131 olabilir. A\u015fa\u011f\u0131daki makale kendi QoL\u2019lerinde ya\u015fam […]","og_url":"https:\/\/bcuni.eu\/tr\/doktor-hasta-iliskisi-ve-iletisimsel-sorunlar\/","og_site_name":"Brussels Capital University","article_published_time":"2021-10-18T17:00:36+00:00","og_image":[{"width":570,"height":265,"url":"https:\/\/bcuni.eu\/tr\/wp-content\/uploads\/2021\/10\/DOKTOR-HASTA-ILISKISI-VE-ILETISIMSEL-SORUNLAR-1.jpg","type":"image\/jpeg"}],"author":"admin","twitter_card":"summary_large_image","twitter_misc":{"Yazan:":"admin","Tahmini okuma s\u00fcresi":"18 dakika"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/bcuni.eu\/tr\/doktor-hasta-iliskisi-ve-iletisimsel-sorunlar\/#article","isPartOf":{"@id":"https:\/\/bcuni.eu\/tr\/doktor-hasta-iliskisi-ve-iletisimsel-sorunlar\/"},"author":{"name":"admin","@id":"https:\/\/bcuni.eu\/tr\/#\/schema\/person\/7827bc312d6272021c9437e91b8119ac"},"headline":"DOKTOR-HASTA \u0130L\u0130\u015eK\u0130S\u0130 VE \u0130LET\u0130\u015e\u0130MSEL SORUNLAR","datePublished":"2021-10-18T17:00:36+00:00","mainEntityOfPage":{"@id":"https:\/\/bcuni.eu\/tr\/doktor-hasta-iliskisi-ve-iletisimsel-sorunlar\/"},"wordCount":3642,"commentCount":0,"publisher":{"@id":"https:\/\/bcuni.eu\/tr\/#organization"},"image":{"@id":"https:\/\/bcuni.eu\/tr\/doktor-hasta-iliskisi-ve-iletisimsel-sorunlar\/#primaryimage"},"thumbnailUrl":"https:\/\/bcuni.eu\/tr\/wp-content\/uploads\/2021\/10\/DOKTOR-HASTA-ILISKISI-VE-ILETISIMSEL-SORUNLAR-1.jpg","articleSection":["Bilimsel Makaleler"],"inLanguage":"tr","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/bcuni.eu\/tr\/doktor-hasta-iliskisi-ve-iletisimsel-sorunlar\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/bcuni.eu\/tr\/doktor-hasta-iliskisi-ve-iletisimsel-sorunlar\/","url":"https:\/\/bcuni.eu\/tr\/doktor-hasta-iliskisi-ve-iletisimsel-sorunlar\/","name":"DOKTOR-HASTA \u0130L\u0130\u015eK\u0130S\u0130 VE \u0130LET\u0130\u015e\u0130MSEL SORUNLAR - 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