Perceived doctor-patient relationship and its association with demoralization in patients with advanced cancer
Perceived doctor-patient relationship and its association with demoralization in patients with advanced cancer
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DOI：
10.1002/pon.4823
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发表时间：
2018-11-01
期刊：
影响因子：
3.6
通讯作者：
Mehnert, Anja
中科院分区：
文献类型：
--
作者：
Garzon, Leonhard Quintero;Koranyi, Susan;Mehnert, Anja
背景晚期疾病给患者带来了巨大的负担，并与生存问题密切相关。士气低落被认为是一种存在痛苦的综合症，感觉无法应对生活意义的丧失以及无助和绝望的感觉。专业医疗保健提供者在为患者提供支持方面发挥着重要作用，他们之间不利的谈话方式可能会增加患者的痛苦。在这项研究中，我们研究了患者与医疗保健提供者的感知关系与士气低落之间的关联。方法 结果 我们使用针对晚期癌症患者（UICC 分期 >= III；PHQ >= 9 和/或 Distress-Thermometer >= 5）的随机对照试验干预研究的基线数据。我们使用QUAL-EC-P的子量表来评估医患关系，使用贝克抑郁量表-II来评估抑郁症状，使用改良版的MSAS作为生理症状检查表，并使用士气低落量表来评估士气低落。计算了层次回归分析。在我们的 187 名 III 期或 IV 期癌症患者（62% 为女性）样本中，53.4% 的患者出现士气低落（16% 中度士气低落；37.4% 高度士气低落）。与医疗保健提供者的关系是士气低落的独立预测因素（beta = -.33，t(186) = -6.70，P < .001）。结论 我们的研究结果强调了医患关系在应对晚期癌症患者生存挑战方面的重要性。关于如何与患者及其具体需求进行沟通和建立可持续关系的培训可能会增加医生的社会支持对患者生存困境的缓冲作用。
Background Advanced diseases pose a great burden on patients and go hand in hand with existential concerns. Demoralization is considered as a syndrome of existential distress with a perceived inability to cope with loss of meaning in life and feelings of helplessness and hopelessness. Professional health care providers play an important role in providing support for patients and unfavorable conversational styles in their relationship can increase patient's distress. In this study, we examine the association between the patient's perceived relationship to health care providers and demoralization. Methods Results We used baseline data of a randomized control trial intervention study for advanced cancer patients (UICC-Stage >= III; PHQ >= 9 and/or Distress-Thermometer >= 5). We used a subscale of the QUAL-EC-P for assessing doctor-patient relationship, Beck Depression Inventory-II for depressive symptoms, a modified version of the MSAS as physiological symptom checklist, and the Demoralization Scale to assess demoralization. A hierarchical regression analysis was calculated. In our sample of 187 patients with stage III or IV cancer (62% women), demoralization was present in 53.4% (16% moderate demoralization; 37.4% high demoralization) of the patients. Relationship to health care provider was an independent predictor (beta = -.33, t(186) = -6.70, P < .001) of demoralization. Conclusions Our findings underline the importance of the physician-patient relationship in the context of coping with existential challenges in advanced cancer patients. Trainings on how to communicate and build a sustainable relationship with patients and their specific needs may increase the buffering effect of social support by the physicians on patient's existential distress.