Bruera E, Neumann C M, Mazzocato C, Stiefel F, Sala R
Division of Symptom Control and Palliative Care, University of Texas, M.D. Anderson Cancer Center, Houston 77030, USA.
Palliat Med. 2000 Jul;14(4):287-98. doi: 10.1191/026921600674582192.
The subject of communication between palliative care physicians and their patients regarding their diagnosis and prognosis has not been extensively researched. The purpose of this survey was to compare the attitudes and beliefs of palliative care specialists regarding communication with the terminally ill in Europe, South America, and Canada. A sample of palliative care physicians from South America (Argentina and Brazil), French-speaking Europe, and Canada were identified, and posted a questionnaire. Physicians who stated that they practised palliative care at least 30% of their time were considered evaluable as palliative care specialists. Of a total of 272 questionnaires, 228 were returned (84%); and 182/228 (81%) respondents were considered to be palliative care specialists. Palliative care physicians in all three regions believed that cancer patients should be informed of their diagnosis and the terminal nature of their illness. Physicians reported that at least 60% of their patients knew their diagnosis and the terminal stage of their illness in 52% and 24% of cases in South America, and 69% and 38% of cases in Europe, respectively. All physicians agreed that 'do not resuscitate' orders should be present, and should be discussed with the patient in all cases. While 93% of Canadian physicians stated that at least 60% of their patients wanted to know about the terminal stage of their illness, only 18% of South American, and 26% of European physicians said this (P < 0.001). Similar results were found when the physicians were asked the percentage of families who want patients to know the terminal stage of their illness. However, almost all of the physicians agreed that if they had terminal cancer they would like to know. There was a significant association between patient based decision-making and female sex (P = 0.007), older age (P = 0.04), and physicians from Canada and South America (P < 0.001). Finally, in their daily decision making, South American physicians were significantly more likely to support beneficence and justice as compared with autonomy. Canadian physicians were more likely to support autonomy as compared with beneficence. In summary, our findings suggest that there are major regional differences in the attitudes and beliefs of physicians regarding communication at the end of life. More research is badly needed on the attitudes and beliefs of patients, families, and health care professionals in different regions of the world.
姑息治疗医生与其患者就诊断和预后进行沟通这一主题尚未得到广泛研究。本次调查的目的是比较欧洲、南美洲和加拿大的姑息治疗专家在与绝症患者沟通方面的态度和信念。确定了来自南美洲（阿根廷和巴西）、法语区欧洲和加拿大的姑息治疗医生样本，并发放了问卷。那些表示至少30%的工作时间从事姑息治疗的医生被视为可作为姑息治疗专家进行评估。在总共272份问卷中，228份被退回（84%）；182/228（81%）的受访者被视为姑息治疗专家。所有三个地区的姑息治疗医生都认为应该告知癌症患者他们的诊断以及病情的晚期性质。医生报告称，在南美洲，分别有52%和24%的病例中至少60%的患者知道自己的诊断和病情的晚期阶段；在欧洲，这两个比例分别为69%和38%。所有医生都同意应该有“不要复苏”的医嘱，并且在所有情况下都应该与患者讨论。虽然93%的加拿大医生表示至少60%的患者想知道自己病情的晚期阶段，但只有18%的南美洲医生和26%的欧洲医生这样说（P<0.001）。当医生被问及希望患者了解病情晚期阶段的家属比例时，也发现了类似的结果。然而，几乎所有医生都同意，如果他们患有晚期癌症，他们希望了解情况。基于患者的决策与女性性别（P = 0.007）、年龄较大（P = 0.04）以及来自加拿大和南美洲的医生（P<0.001）之间存在显著关联。最后，在日常决策中，与自主性相比，南美洲医生更有可能支持行善和公正。与行善相比，加拿大医生更有可能支持自主性。总之，我们的研究结果表明，医生在临终沟通方面的态度和信念存在重大地区差异。世界不同地区的患者、家属和医疗保健专业人员的态度和信念急需更多研究。
