Intended and unintended consequences: Ethics, communication, and prognostic disclosure in pediatric oncology.
Intended and unintended consequences: Ethics, communication, and prognostic disclosure in pediatric oncology.
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作者：
Marron JM;Cronin AM;Kang TI;Mack JW
大多数患者希望获得所有可用的预后信息，但一些医生不愿讨论预后。我们的目的是检查癌症儿童父母的预后披露结果。我们调查了两个三级癌症中心的 353 名新诊断癌症儿童的家长以及每个孩子的肿瘤科医生。使用多变量逻辑回归，我们评估了家长报告的与肿瘤科医生进行预后讨论的要素（信息/沟通的质量、预后披露）与这些讨论的潜在后果（信任、希望、安心、预后理解、抑郁、焦虑）之间的关联。根据肿瘤学家报告的预后对分析进行分层。预后信息的披露与父母焦虑、抑郁或希望的减少无关。在预后较差（治愈机会<75%）的儿童的父母中，从肿瘤科医生处获得高质量信息与更大的内心平静（OR 5.23 [1.81, 15.16]）和沟通相关的希望（OR 2.54 [1.00, 6.40]）相关。高质量的肿瘤科医生沟通方式与对医生的更大信任（OR 2.45 [1.09，5.48]）和希望（OR 3.01 [1.26，7.19]）相关。在预后较差的儿童的父母中，准确的预后理解不太常见（OR 0.39 [0.17, 0.88]）。接收高质量信息、高质量沟通和预后披露与更准确的预后理解没有显着相关性。我们没有发现任何证据表明披露与焦虑、抑郁或希望减少有关。沟通过程可以增加内心的平静、信任和希望。目前尚不清楚如何最好地增强对预后的理解。
Most patients desire all available prognostic information, but some physicians hesitate to discuss prognosis. We aimed to examine outcomes of prognostic disclosure among parents of children with cancer. We surveyed 353 parents of children with newly diagnosed cancer at two tertiary cancer centers, and each child’s oncologist. Using multivariable logistic regression, we assessed associations between parental report of elements of prognosis discussions with the oncologist (quality of information/communication, prognostic disclosure) and potential consequences of these discussions (trust, hope, peace of mind, prognostic understanding, depression, anxiety). Analyses were stratified by oncologist-reported prognosis. Prognostic disclosure was not associated with increased parental anxiety, depression, or decreased hope. Among parents of children with less favorable prognoses (<75% chance of cure), receipt of high-quality information from the oncologist was associated with greater peace of mind (OR 5.23 [1.81, 15.16]) and communication-related hope (OR 2.54 [1.00, 6.40]). High-quality oncologist communication style was associated with greater trust in the physician (OR 2.45 [1.09, 5.48]) and hope (OR 3.01 [1.26, 7.19]). Accurate prognostic understanding was less common among parents of children with less favorable prognoses (OR 0.39 [0.17, 0.88]). Receipt of high-quality information, high-quality communication, and prognostic disclosure were not significantly associated with more accurate prognostic understanding. We find no evidence that disclosure is associated with anxiety, depression, or decreased hope. Communication processes may increase peace of mind, trust, and hope. It remains unclear how best to enhance prognostic understanding.
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影响因子：
28.4
作者：
Epstein RM;Duberstein PR;Fenton JJ;Fiscella K;Hoerger M;Tancredi DJ;Xing G;Gramling R;Mohile S;Franks P;Kaesberg P;Plumb S;Cipri CS;Street RL Jr;Shields CG;Back AL;Butow P;Walczak A;Tattersall M;Venuti A;Sullivan P;Robinson M;Hoh B;Lewis L;Kravitz RL
通讯作者：
Kravitz RL
影响因子：
6.2
作者：
Greenzang, Katie A.;Cronin, Angel M.;Mack, Jennifer W.
通讯作者：
Mack, Jennifer W.
影响因子：
45.3
作者：
Temel, Jennifer S.;Greer, Joseph A.;Pirl, William F.
通讯作者：
Pirl, William F.
影响因子：
2.2
作者：
Gordon, EJ;Daugherty, CK
通讯作者：
Daugherty, CK
影响因子：
45.3
作者：
Mack, Jennifer W.;Wolfe, Joanne;Weeks, Jane C.
通讯作者：
Weeks, Jane C.