Doctor-patient interactions in oncology
Doctor-patient interactions in oncology
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DOI：
10.1016/0277-9536(95)00265-0
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发表时间：
1996-06-01
影响因子：
5.4
通讯作者：
Lewis, S
中科院分区：
文献类型：
--
作者：
Ford, S;Fallowfield, L;Lewis, S
将内容分析技术应用于癌症咨询的研究很少。这项描述性研究调查了117名新转诊到伦敦一家大型教学医院肿瘤科的门诊患者的坏消息癌症咨询的结构和内容。根据以往的传播学研究，形成了三个主要假设：(I)癌症咨询以临床医生为主，而不是以患者为中心；(Ii)临床医生和患者之间的心理社会讨论水平较低；(Iii)患者的性别、年龄和预后类别等特征影响临床医生的行为。每个患者都与5位肿瘤学家中的一位进行了两次会诊。在征得患者同意的情况下，这两项记录都被录了下来。使用Roter互动分析系统对磁带进行内容编码。结果显示，临床医生倾向于使用封闭式问题，而不是开放式问题。患者很少提问，也很少有空间发起讨论。因此，以病人为中心的水平很低。尽管会诊涉及危及生命的疾病，而且往往包含关于已知会引起心理障碍的毒性治疗的信息，但与患者心理健康有关的问题很少。双方关于医学话题的讨论量是心理社会讨论量的2.5倍。尽管有数据表明，3名临床医生根据患者的年龄和预后组表现出不同的行为，但每名医生的患者数量很少。患者对自己的诊断、预后和治疗方案都很了解，但很少有人探讨他们的情绪健康状况。(C)1996年爱思唯尔科学有限公司
Studies which apply content analysis techniques to the cancer consultation are few. This descriptive study examines the structure and content of the bad news cancer consultations of 117 out-patients newly referred to the Medical Oncology Department of a large London teaching hospital. From previous communication research three main hypotheses are formed: (i) the cancer consultation is clinician-dominated rather than patient-centred; (ii) the level of psychosocial discussion between clinicians and patients is low and (iii) patient characteristics such as sex, age and prognostic category influence clinician behaviours. Each patient had two consultations with one of 5 oncologists. Both these were audiotaped with the patients' consent. The tapes were content coded using the Roter Interaction Analysis System. Results showed that clinicians tended to use closed rather than open questions. Patients asked few questions and were seldom given space to initiate discussion. Thus, the level of patient-centredness was low. Despite the fact that consultations concerned life threatening disease and often contained information regarding toxic treatment which is known to provoke psychological dysfunction, the number of questions relating to patients' psychological health were few. The amount of discussion concerning medical topics from both parties was 2.5 times greater than the amount of psychosocial discussion. Although there was a suggestion in the data that 3 clinicians showed variations in behaviour according to patient age and prognostic group, the number of patients for each doctor was small. Patients were well informed about their diagnosis, prognosis and treatment options, but their emotional well-being was rarely probed. (C) 1996 Elsevier Science Ltd