Communicating with realism and hope: Incurable cancer patients' views on the disclosure of prognosis
Communicating with realism and hope: Incurable cancer patients' views on the disclosure of prognosis
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DOI：
10.1200/jco.2005.11.138
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发表时间：
2005-02-20
影响因子：
45.3
通讯作者：
Tattersall, MHN
中科院分区：
文献类型：
--
作者：
Hagerty, RG;Butow, PN;Tattersall, MHN
目的 确定无法治愈的转移性癌症患者对预后讨论过程的偏好以及与这些偏好相关的变量。患者和方法 受邀参加研究的 218 名患者中有 126 名 (58%) 参与。合格患者为30名肿瘤科医生的连续转移性癌症患者，招募前6周至6个月内被诊断，年龄超过18岁，无已知精神疾病。患者完成了一项邮寄调查，测量患者对预后信息传递方式的偏好，包括医生如何灌输希望。结果 98% 的患者希望他们的医生现实，提供提问的机会，并在讨论预后时承认他们是一个个体。医生认为最给予希望的行为包括提供最新的治疗（90%）、似乎了解患者癌症的所有信息（87%）以及表示疼痛将得到控制（87%）。大多数患者表示，医生表现得紧张或不舒服（91%）、首先向家人告知预后（87%）或使用委婉说法（82%）都不会带来希望。因素分析揭示了六种一般风格和三个希望因素；最受认可的风格是现实主义和个性化护理以及专家/积极/协作方法。一系列人口统计学、心理和疾病因素与偏好的一般和给予希望的方式相关，包括焦虑、信息寻求行为、预期生存率和年龄。 结论 在讨论预后时，大多数患者更喜欢癌症专家提供的现实和个性化的方法以及详细信息。
Purpose To identify preferences for the process of prognostic discussion among patients with incurable metastatic cancer and variables associated with those preferences.Patients and Methods One hundred twenty-six (58%) of 218 patients invited onto the study participated. Eligible patients were the consecutive metastatic cancer patients of 30 oncologists, who were diagnosed within 6 weeks to 6 months before recruitment, over 18 years of age, and without known mental illness. Patients completed a postal survey measuring patient preferences for the manner of delivery of prognostic information, including how doctors might instill hope.Results Ninety-eight percent of patients wanted their doctor to be realistic, provide an opportunity to ask questions, and acknowledge them as an individual when discussing prognosis. Doctor behaviors rated the most hope giving included offering the most up to date treatment (90%), appearing to know all there is to know about the patient's cancer (87%), and saying that pain will be controlled (87%). The majority of patients indicated that the doctor appearing to be nervous or uncomfortable (91%), giving the prognosis to the family first (87%), or using euphemisms (82%) would not facilitate hope. Factor analysis revealed six general styles and three hope factors; the most strongly endorsed styles were realism and individualized care and the expert/positive/collaborative approach. A range of demographic, psychological, and disease factors were associated with preferred general and hope-giving styles, including anxiety, information-seeking behavior, expected survival, and age.Conclusion The majority of patients preferred a realistic and individualized approach from the cancer specialist and detailed information when discussing prognosis.