'It's going to shorten your life': framing of oncologist-patient communication about prognosis.
'It's going to shorten your life': framing of oncologist-patient communication about prognosis.
复制标题
“这会缩短你的生命”：肿瘤科医生与患者关于预后的沟通框架。
DOI：
10.1002/pon.1223
复制
发表时间：
2008
期刊：
影响因子：
3.6
通讯作者：
Arnold,RobertM
中科院分区：
文献类型：
--
作者：
Rodriguez,KeriL;Gambino,FrankJ;Butow,PhyllisN;Hagerty,RebeccaG;Arnold,RobertM
在这项定性研究中，我们使用扎根理论技术来分析29例肿瘤学家与以前诊断为无法治愈的癌症的患者首次接触的记录。我们发现23份（79%）的转录本包括166例预后谈话。使用的语言从一般到个人不等，25%的陈述没有提到病人（例如，“肿瘤通常会复发”），13%的陈述提到了目前病人以外的病人（例如，“一些肿瘤反应的病人会活2-5年”），11%的陈述在其他人的背景下提到了目前的病人（例如，“平均来说，像你这样的人活几年”），51%的陈述直接关注病人（例如，“这个东西最终会杀了你”）。治疗相关预后多于疾病相关预后（67%对33%）。31%的陈述关注消极结果（损失框架），其余的要么关注积极结果（收益框架），要么讨论积极和消极结果的结合（混合框架）。当讨论集中在负面结果时，通常使用一般和间接的语言，可能是为了缓冲患者对预后不良的消息。版权所有©2007 John Wiley & Sons， Ltd
In this qualitative study, we used grounded theory techniques to analyze transcripts of 29 first‐time encounters between oncologists and patients referred to them with previously diagnosed, incurable cancer. We found that 23 (79%) of the transcripts included 166 examples of prognostic talk. The language used ranged from general to personal, with 25% of statements mentioning no patients (e.g., ‘the tumor will usually come back’), 13% mentioning patients other than the current patient (e.g., ‘some patients with tumor response will be around for 2–5 years’), 11% mentioning the current patient in the context of others (e.g., ‘on average, people like you live a couple of years’), and 51% directly focusing on the patient (e.g., ‘this thing's going to kill you eventually’). More statements pertained to treatment‐related prognosis than to disease‐related prognosis (67 versus 33%). While 31% of statements focused on negative outcomes (loss framing), the remainder either focused on positive outcomes (gain framing) or discussed a combination of positive and negative outcomes (mixed framing). When discussions focused on negative outcomes, general and indirect language was commonly used, perhaps to buffer the patient from news of the poor prognosis. Copyright © 2007 John Wiley & Sons, Ltd.