Evaluating relationships between lung cancer stigma, anxiety, and depressive symptoms and the absence of empathic opportunities presented during routine clinical consultations.
Evaluating relationships between lung cancer stigma, anxiety, and depressive symptoms and the absence of empathic opportunities presented during routine clinical consultations.
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评估肺癌污名，焦虑和抑郁症状之间的关系，以及在常规临床咨询期间缺乏同情机会。
DOI：
10.1016/j.pec.2020.08.005
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发表时间：
2021-03
影响因子：
3.5
通讯作者：
Shen MJ
中科院分区：
文献类型：
--
作者：
Williamson TJ;Ostroff JS;Martin CM;Banerjee SC;Bylund CL;Hamann HA;Shen MJ
临床咨询中的共情沟通是相互构建的，患者首先提出共情机会（表达情感，挑战或进展的陈述），临床医生可以对此做出回应。我们假设，在常规会诊中没有表现出共情机会的肺癌患者比表现出至少一种共情机会的患者报告更高的耻辱感、焦虑和抑郁症状。肺癌患者（N = 56）和临床医生之间的音频记录的咨询进行了分析，以确定共情的机会。参与者完成了测量社会人口和心理社会特征的问卷调查。21次咨询（38%）不包含共情机会。出乎意料的是，呈现移情机会和患者种族之间存在显著的相互作用（即，讨论癌症时的不适感（F = 4.49，p = .041）和焦虑（F = 8.03，p = .007）。在少数种族患者中（自认为是黑人/非裔美国人，亚洲人/太平洋岛民或其他种族），那些没有表现出共情机会的患者比那些至少表现出共情机会的患者报告了更高的耻辱感（t =-5.47，p = .038），但在白色患者中没有观察到这种差异（t = 0.38，p = .789）。焦虑症也出现了其他统计学上显著的发现。披露相关的耻辱和焦虑可以解释为什么有些患者呈现共情的机会，而其他人没有。临床医生应该有意识地引发共情的机会，并鼓励与患者（特别是来自不同种族背景的患者）进行开放式沟通。
Empathic communication in clinical consultations is mutually constructed, with patients first presenting empathic opportunities (statements communicating emotions, challenges, or progress) to which clinicians can respond. We hypothesized that lung cancer patients who did not present empathic opportunities during routine consultations would report higher stigma, anxiety, and depressive symptoms than patients who presented at least one. Audio-recorded consultations between lung cancer patients (N = 56) and clinicians were analyzed to identify empathic opportunities. Participants completed questionnaires measuring sociodemographic and psychosocial characteristics. Twenty-one consultations (38 %) did not contain empathic opportunities. Unexpectedly, there was a significant interaction between presenting empathic opportunities and patients’ race on disclosure-related stigma (i.e., discomfort discussing one’s cancer; F = 4.49, p = .041) and anxiety (F = 8.03, p = .007). Among racial minority patients (self-identifying as Black/African American, Asian/Pacific Islander, or other race), those who did not present empathic opportunities reported higher stigma than those who presented at least one (t = −5.47, p = .038), but this difference was not observed among white patients (t = 0.38, p = .789). Additional statistically significant findings emerged for anxiety. Disclosure-related stigma and anxiety may explain why some patients present empathic opportunities whereas others do not. Clinicians should intentionally elicit empathic opportunities and encourage open communication with patients (particularly from diverse racial backgrounds).
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