Oncologists' attitudes toward and practices in giving bad news: An exploratory study
Oncologists' attitudes toward and practices in giving bad news: An exploratory study
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DOI：
10.1200/jco.2002.08.004
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发表时间：
2002-04-15
影响因子：
45.3
通讯作者：
Cohen, L
中科院分区：
文献类型：
--
作者：
Baile, WF;Lenzi, R;Cohen, L
目的：调查肿瘤科医生在向癌症患者披露不利医疗信息时的态度和做法。方法：对参加 1999 年美国临床肿瘤学会年会的一组医生进行问卷调查。 The questionnaire assessed demographic and practice-related information and the frequency of patient encounters in which unfavorable cancer-related information was disclosed.参与者还被问及在进行压力性讨论时遇到的困难以及在提供不利信息时使用的沟通策略。结果：调查问卷由 167 名肿瘤科医生完成。百分之六十四是肿瘤内科医生。 38% 在北美执业，26% 在欧洲执业，13% 在南美执业，13% 在亚洲执业。参与者平均每月向患者报告坏消息 35 次。据报道，讨论没有进一步的治疗和临终关怀是最困难的。在披露癌症诊断和预后时，与其他国家的医生相比，西方国家的医生不太可能应患者家属的要求隐瞒对患者不利的信息，完全避免讨论，使用委婉语，并给予已知无效的治疗，以免摧毁希望。关于讨论复苏的最佳时间，人们的意见存在显着差异，18% 的受访者认为应该在生命即将结束时进行复苏。结论：医生向癌症患者披露信息的方式存在显着差异。地理区域、文化和家庭变量等因素可能是这一过程的重要影响因素。 (C) 2002 年，美国临床肿瘤学会。
Purpose : To examine the attitudes and practices of oncologists in disclosure of unfavorable medical information to cancer patients.Methods: A questionnaire was administered to a group of physicians who attended the 1999 Annual Meeting of the American Society of Clinical Oncology. The questionnaire assessed demographic and practice-related information and the frequency of patient encounters in which unfavorable cancer-related information was disclosed. Participants were also asked about difficulties they had when approaching stressful discussions and communication strategies used in giving unfavorable information.Results: The questionnaire was completed by 167 oncologists. Sixty-four percent were medical oncologists. Thirty-eight percent practiced in North America, 26% practiced in Europe, 13% practiced in South America, and 13% practiced in Asia. Participants gave bad news to patients an average of 35 times per month. Discussing no further curative treatment and hospice was reported as most difficult. In disclosing the cancer diagnosis and prognosis, physicians from Western countries were less likely to withhold unfavorable information from the patient at the family's request, avoid the discussion entirely, use euphemisms, and give treatments known not to be effective so as not to destroy hope than physicians from other countries. There was significant variability in opinions regarding the best time to discuss resuscitation, with 18% of respondents believing that it should be done close to the end of life.Conclusion: There was significant variability in how physicians approach information disclosure to cancer patients. Factors such as geographical region and cultural and family variables may be important influences in this process. (C) 2002 by American Society of Clinical Oncology.