Hope and prognostic disclosure
Hope and prognostic disclosure
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DOI：
10.1200/jco.2007.12.6110
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发表时间：
2007-12-10
影响因子：
45.3
通讯作者：
Weeks, Jane C.
中科院分区：
文献类型：
--
作者：
Mack, Jennifer W.;Wolfe, Joanne;Weeks, Jane C.
目的
医生有时会有选择性地传达预后信息以支撑患者的希望。然而，预后告知与希望之间的关系尚不明确。
患者与方法
我们对在丹娜 - 法伯癌症研究所和儿童医院（马萨诸塞州波士顿市）接受治疗第一年的194名癌症患儿的家长进行了调查（总体回复率为70%），同时也对患儿的医生进行了调查。我们评估了家长所回忆的医生告知预后情况与可能的结果之间的关系，这些结果包括希望、信任和情绪困扰。我们通过询问家长患儿的肿瘤医生与他们就患儿癌症进行交流的方式让他们感到有希望的频率来评估主要结果。
结果
近一半的家长报告说医生的交流总是让他们感到有希望。报告接收到更多预后告知内容的家长更有可能报告与交流相关的希望（比值比[OR]，每一项告知内容为1.77；P = 0.001），即使治愈的可能性很低时也是如此（治愈可能性<25%时，每一项告知内容的比值比为5.98；P = 0.03）。在一个多变量模型中，当家长还报告接收到更多预后告知内容（比值比为1.60；P = 0.03）以及高质量的交流（比值比为6.58；P < 0.0001）时，他们更有可能报告医生的交流总是让他们感到有希望。与交流相关的希望与患儿的治愈可能性呈负相关（比值比为0.65；P = 0.005）。
结论
尽管医生有时会限制预后信息以保留希望，但我们没有发现证据表明预后告知会让家长感到希望减少。相反，医生告知预后情况甚至在预后不佳时也能支撑希望。
PurposePhysicians sometimes selectively convey prognostic information to support patients' hopes. However, the relationship between prognostic disclosure and hope is not known.Patients and MethodsWe surveyed 194 parents of children with cancer (overall response rate, 70%) in their first year of treatment at the Dana-Farber Cancer Institute and Children's Hospital (Boston, MA), and we surveyed the children's physicians. We evaluated relationships between parental recall of prognostic disclosure by the physician and possible outcomes, including hope, trust, and emotional distress. Our main outcome was assessed by asking parents how often the way the child's oncologist communicated with them about the children's cancers made them feel hopeful.ResultsNearly half of parents reported that physician communication always made them feel hopeful. Parents who reported receiving a greater number of elements of prognostic disclosure were more likely to report communication-related hope (odds ratio [OR], 1.77 per element of disclosure; P = .001), even when the likelihood of a cure was low (OR, 5.98 per element of disclosure with likelihood of a cure < 25%; P = .03). In a multivariable model, parents were more likely to report that physician communication always made them feel hopeful when they also reported receipt of more elements of prognostic disclosure (OR, 1.60; P = .03) and high-quality communication (OR, 6.58; P < .0001). Communication- related hope was inversely associated with the child's likelihood of cure (OR, 0.65; P = .005).ConclusionAlthough physicians sometimes limit prognostic information to preserve hope, we found no evidence that prognostic disclosure makes parents less hopeful. Instead, disclosure of prognosis by the physician can support hope, even when the prognosis is poor.