What is your understanding of your illness? A communication tool to explore patients' perspectives of living with advanced illness.
What is your understanding of your illness? A communication tool to explore patients' perspectives of living with advanced illness.
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您对自己的病情有何了解？
DOI：
10.1007/s11606-012-2109-2
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发表时间：
2012
影响因子：
5.7
通讯作者：
Steinhauser,KarenE
中科院分区：
文献类型：
--
作者：
Morris,DeborahA;Johnson,KimberlyS;Ammarell,Natalie;Arnold,RobertM;Tulsky,JamesA;Steinhauser,KarenE
提供者沟通课程和指南强调使用开放式问题，如“你对自己的疾病有什么了解？”探索病人对他们疾病严重程度的看法，但目前的文献中基本上没有对病人反应的描述。这些问题是最常用的临床医生，因为他们提供坏消息给癌症患者或地址代码状态在生命的尽头，但还没有得到很好的研究，在其他疾病或早期的疾病course.ProstitivesTo探索的反应，患者的生活与严重的疾病的问题“什么是你的理解你的疾病？”并确定癌症和非癌症患者在讨论他们的疾病时所使用的主题和语言的异同。我们对患者对“你对自己的疾病有什么理解？”参与者209例受试者，69例癌症患者，70例CHF患者，70例COPD患者，2年生存率估计为50%。平均年龄为66岁。APPROACHResponses是在一项更大的、对晚期生命限制性疾病（癌症、CHF或COPD）患者的纵向研究的基线访谈时记录的。在使用开放编码进行主题内容分析后，研究人员进行模式分析，以检查与诊断相关的变化。我们确定了五个主要主题：命名诊断或描述病理生理学，病史，预后，症状和因果关系。反应因诊断而异。癌症患者的反应更经常包括具体的诊断细节和预后，而非癌症患者的参考症状和causation.CONCLUSIONSPatients '的开放式问题的反应“什么是你的理解你的疾病？”可以为临床医生提供重要的信息和见解，了解他们如何看待他们在非急性环境中的疾病。所确定的主题可以作为以患者为中心的沟通策略的基础，因为我们努力与患者建立对疾病的相互理解。
BACKGROUNDProvider communication courses and guidelines stress the use of open-ended questions, such as “what is your understanding of your illness?,” to explore patients’ perceptions of their illness severity, yet descriptions of patients’ responses are largely absent from the current literature. These questions are most often used by clinicians as they deliver bad news to cancer patients or address code status at the end of life, but have not been well studied in other diseases or earlier in the disease course.OBJECTIVESTo explore the responses of patients living with serious illness to the question “what is your understanding of your illness?” and to identify similarities and differences in themes and language used by cancer and non-cancer patients to discuss their illness.DESIGNWe conducted a qualitative analysis of patients’ responses to “what is your understanding of your illness?”PARTICIPANTSTwo hundred nine subjects, 69 with cancer, 70 CHF, and 70 COPD, who had an estimated 50 % 2-year survival. Mean age was 66 years.APPROACHResponses were recorded at the baseline interview of a larger, longitudinal study of patients with advanced life-limiting illness (cancer, CHF, or COPD). After thematic content analysis using open coding, investigators conducted pattern analysis to examine variation associated with diagnosis.RESULTSWe identified five major themes: naming the diagnosis or describing the pathophysiology, illness history, prognosis, symptoms, and causality. Responses varied by diagnosis. Cancer patients’ responses more often included specific diagnostic details and prognosis, while non-cancer patients referenced symptoms and causality.CONCLUSIONSPatients’ responses to the open-ended question “what is your understanding of your illness?” can provide the clinician with important information and insight on how they view their illness in a non-acute setting. The identified themes can serve as a foundation for patient-centered communication strategies as we strive to build a mutual understanding of illness with patients.