Lampic C, Sjödén P O
Department of Public Health and Caring Sciences, Uppsala University, Sweden.
Acta Oncol. 2000;39(1):9-22. doi: 10.1080/028418600430923.
This paper reviews patient and staff perceptions of cancer patients' psychological concerns and needs. An extensive literature search resulted in a total of 22 studies. Six of these concern staff ratings of hypothetical 'average' patients, and the main findings are that staff and patients are in relative agreement about the overall spectrum of concerns relevant to cancer patients, but less so regarding which concerns are of most importance to patients. Sixteen studies compare patient ratings with staff ratings of individual patients. The overall pattern of results indicates that staff tend to overestimate patient anxiety and emotional distress and show limited ability adequately to assess patient distress in terms of rank. Staff were able correctly to detect a majority of anxiety 'cases', while the identification of depression was less accurate. High detection rates for anxiety were obtained partly at the expense of staff also presuming anxiety in many non-distressed patients. Generally, there was better patient-staff agreement on the absence than the presence of patient anxiety and depression. Many studies were found to have serious methodological deficiencies and there is no clear evidence that patient-staff agreement is markedly better in studies fulfilling important methodological criteria. Several explanations of patient-staff discrepancies are discussed. Future research should be aimed at critically testing possible reasons for patient-staff disagreement and at investigating the consequences of such discrepancies.
本文综述了患者及医护人员对癌症患者心理问题及需求的看法。广泛的文献检索共得到22项研究。其中6项涉及医护人员对假设的“普通”患者的评分，主要发现是，医护人员和患者在与癌症患者相关的总体问题范围上相对一致，但在哪些问题对患者最重要方面则不太一致。16项研究比较了患者评分与医护人员对个体患者的评分。结果的总体模式表明，医护人员往往高估患者的焦虑和情绪困扰，并且在根据等级充分评估患者困扰方面能力有限。医护人员能够正确检测出大多数焦虑“病例”，而对抑郁的识别则不太准确。焦虑的高检测率部分是以医护人员在许多无困扰患者中也假定存在焦虑为代价的。总体而言，对于患者不存在焦虑和抑郁的情况，医患之间的一致性比对存在焦虑和抑郁的情况更好。许多研究存在严重的方法学缺陷，而且没有明确证据表明，在满足重要方法学标准的研究中，医患之间的一致性明显更好。文中讨论了医患差异的几种解释。未来的研究应旨在严格检验医患分歧的可能原因，并调查此类差异的后果。
