'Hitting you over the head': Oncologists' disclosure of prognosis to advanced cancer patients
'Hitting you over the head': Oncologists' disclosure of prognosis to advanced cancer patients
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DOI：
10.1111/1467-8519.00330
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发表时间：
2003-04-01
期刊：
影响因子：
2.2
通讯作者：
Daugherty, CK
中科院分区：
文献类型：
--
作者：
Gordon, EJ;Daugherty, CK
在美国，由于对患者参与医疗决策的要求越来越高，向绝症患者披露预后已成为最近的一个关切。作为知情同意程序的一部分，美国医生在法律和伦理上有义务向这类患者提供关于所有可用治疗方案的风险、好处和替代方案的信息，包括使用实验疗法。虽然没有法律要求，但披露晚期预后在伦理上是合理的，因为它维护了自决的原则，使患者能够做出与他们的生活目标一致的治疗决定。为了了解肿瘤学家对向晚期癌症患者披露预后信息的态度，我们采访了14位肿瘤学家，并进行了一个医学研究员的焦点小组。尽管肿瘤学家报告了以无法治愈的癌症来披露预后，但他们倾向于避免使用百分比来表达预后。据报道，肿瘤学家不愿透露预后，这是通过使用隐喻来传达的，这些隐喻描述了此类信息对患者的暴力影响。肿瘤学家不愿透露预后，不愿保留患者的希望，这是因为他们需要确保患者对治疗有“现实的期望”。我们从预后披露的文化、伦理和法律层面、患者的希望和医患关系方面对这些数据进行了讨论，并推荐了加强沟通过程的方法。
The disclosure of prognosis to terminally ill patients has emerged as a recent concern given greater demands for patient involvement in medical decision-making in the United States. As part of the informed consent process, American physicians are legally and ethically obligated to provide information to such patients about the risks, benefits, and alternatives of all available treatment options including the use of experimental therapies. Although not legally required, the disclosure of a terminal Prognosis is ethically justified because it upholds the Principle of self-determination and enables patients to make treatment decisions consistent with their life goals. To understand oncologists' attitudes about disclosing prognostic information to cancer patients with advanced disease, we interviewed fourteen oncologists and conducted one focus group of medical fellows. Although oncologists reported to disclose prognosis in terms Of cancer not being curable, they tend to avoid using percentages to convey prognosis. Oncologists' reported reluctance to disclosing prognosis was conveyed through the use of metaphors depicting the perceived violent impact of such information on patients. Oncologists' reluctance to disclose prognosis and preserve patient hope are held in check by their need to ensure that patients have 'realistic expectations' about therapy. We discuss these data in light of the cultural, ethical, and legal dimensions of prognosis disclosure, patient hope and the doctor-patient relationship, and recommend ways to enhance the communication process.