Patient and caregiver perceptions of communication of prognosis in high grade glioma
Patient and caregiver perceptions of communication of prognosis in high grade glioma
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DOI：
10.1007/s11060-010-0495-z
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发表时间：
2011-08-01
影响因子：
3.9
通讯作者：
Nowak, A. K.
中科院分区：
文献类型：
--
作者：
Lobb, E. A.;Halkett, G. K. B.;Nowak, A. K.
这项研究征求了患者和他们的照顾者对他们被诊断为高级别胶质瘤的经验的看法。采用目的抽样的方法，从某三级医院肿瘤科招募了19名患者和21名护理员。进行了半结构化的面对面访谈。采访被录音并逐字转录。数据以扎根理论为基础，采用常量比较法进行分析。本文着重于患者和护理人员对高级别胶质瘤诊断和预后的初步沟通的看法。确定的主题包括：(A)听到诊断时的震惊；(B)在仍处于休克中时试图理解和处理预后信息；(C)感觉希望被夺走；(D)对预后信息的个人化；以及(E)临床医生缺乏沟通技能。这项研究表明，与高级别胶质瘤患者及其照顾者沟通预后的第一步需要仔细谈判。它说明了在最初的休克和痛苦状态下，个体无法处理详细的预后信息。强调了在沟通预后不良的过程中平衡诚实和希望的重要性。我们建议临床医生根据患者需要的信息量和类型寻求患者的偏好，并将预后信息个体化。关于预后的详细讨论应该只与高级医务人员或表现出可接受的沟通技能的高级实习生进行。
This study sought the views of patients and their caregivers on their experience of being diagnosed with high grade glioma. Purposive sampling was used to recruit 19 patients and 21 caregivers from the medical oncology unit of a tertiary hospital. A semi-structured face-to-face interview was conducted. Interviews were audio-taped and transcribed verbatim. Data was analysed based on Grounded Theory and using the constant comparison method. This paper focuses on patient and carer perceptions of the initial communication about the diagnosis of high grade glioma and its prognosis. Themes identified included: (a) shock at hearing the diagnosis; (b) trying to understand and process prognostic information when still in shock; (c) the perception of hope being taken away; (d) individualizing prognostic information; and (e) clinicians' lack of communication skills. This study shows that the first communication of prognosis to patients with high grade glioma and their caregivers requires careful negotiation. It illustrates the inability of individuals to process detailed prognostic information when in a state of initial shock and distress. The importance of balancing honesty with hope in the communication of a poor prognosis is highlighted. We recommend that clinicians seek patient preferences for the amount and type of information they require and that prognostic information be individualized. Detailed discussions of prognosis should only take place with senior medical staff, or advanced trainees who have demonstrated acceptable communication skills.