Patient-physician communication about early stage prostate cancer: analysis of overall visit structure
Patient-physician communication about early stage prostate cancer: analysis of overall visit structure
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DOI：
10.1111/hex.12168
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发表时间：
2015-10-01
影响因子：
3.2
通讯作者：
Holmes-Rovner, Margaret
中科院分区：
文献类型：
--
作者：
Henry, Stephen G.;Czarnecki, Danielle;Holmes-Rovner, Margaret
研究背景我们对前列腺癌诊治过程中医患沟通了解甚少。目的探讨新发前列腺癌患者就诊时的总体就诊结构及患者与医生在就诊期间的交流活动转换情况。参与者：退伍军人医疗中心的40名退伍军人和18名泌尿科医生。方法对40份访问记录进行编码，识别访问期间的主要交流活动，并使用经验话语分析分析活动之间的过渡。结果我们确定了以下典型顺序发生的五种沟通活动：“诊断交付”，“风险分类”，“选项谈话”，“决策谈话”和“下一步”。前两项活动通常是简短的，患者参与最少。期权谈判通常是最长的活动；医生们明确宣布开始进行选择讨论，并将其视为他们的职业责任。一些患者不确定访问的目的和/或谁应该做出治疗决定。结论对早期前列腺癌进行诊断的访视应遵循常规的沟通活动顺序。医生专注于讨论治疗方案，相对较少的时间和精力用于讨论新的癌症诊断。为了促进以患者为中心的沟通，医生应该考虑在诊断后引起患者的反应，并在描述治疗方案之前解释决策过程。
Background We know little about patient-physician communication during visits to discuss diagnosis and treatment of prostate cancer.Objective To examine the overall visit structure and how patients and physicians transition between communication activities during visits in which patients received new prostate cancer diagnoses.Participants Forty veterans and 18 urologists at one VA medical centre.Methods We coded 40 transcripts to identify major communication activities during visits and used empiric discourse analysis to analyse transitions between activities.Results We identified five communication activities that occurred in the following typical sequence: 'diagnosis delivery', 'risk classification', 'options talk', 'decision talk' and 'next steps'. The first two activities were typically brief and involved minimal patient participation. Options talk was typically the longest activity; physicians explicitly announced the beginning of options talk and framed it as their professional responsibility. Some patients were unsure of the purpose of visit and/or who should make treatment decisions.Conclusion Visits to deliver the diagnosis of early stage prostate cancer follow a regular sequence of communication activities. Physicians focus on discussing treatment options and devote comparatively little time and attention to discussing the new cancer diagnosis. Towards the goal of promoting patient-centred communication, physicians should consider eliciting patient reactions after diagnosis delivery and explaining the decision-making process before describing treatment options.