McWilliam C L, Brown J B, Stewart M
Faculty of Health Sciences, H.S.A., University of Western Ontario, London, Canada.
Patient Educ Couns. 2000 Feb;39(2-3):191-204. doi: 10.1016/s0738-3991(99)00040-3.
The traumas of diagnosis and treatment for breast cancer are well researched and generally addressed in care. While women with breast cancer continue to identify the need for better communication with physicians, studies to date have not investigated how the process of communication between physicians and women with breast cancer actually unfolds. This phenomenological study therefore explored how women with breast cancer experience patient-physician communication to gain a greater understanding of effective approaches. Interviews of a purposeful sample of 11 women within 6 months of initial diagnosis or recurrence of breast cancer were audiotaped, transcribed verbatim and analyzed using inductive interpretation. Themes and patterns of positive and negative experiences emerged. All experiences began with the woman's feeling of vulnerability. In positive experiences, information sharing and relationship building were inextricably linked components of a working relationship which was at the same time affective, behavioural and instrumental. This experience, in turn, influenced the woman's experience of control and mastery of the illness experience, and their experience of learning to live with breast cancer. Findings illuminate the importance of comprehensively patient-centred, working relationships. Several specific techniques to enhance effective communication are identified.
乳腺癌诊断和治疗过程中的创伤已得到充分研究，并且在护理中通常会得到解决。虽然乳腺癌患者仍认为有必要与医生进行更好的沟通，但迄今为止的研究尚未探讨医生与乳腺癌患者之间的沟通过程实际上是如何展开的。因此，这项现象学研究探讨了乳腺癌患者如何体验医患沟通，以更好地理解有效的沟通方式。对11名在乳腺癌初次诊断或复发后6个月内的女性进行了有目的抽样访谈，访谈进行了录音，逐字转录，并采用归纳性解释进行分析。出现了积极和消极经历的主题和模式。所有经历都始于女性的脆弱感。在积极的经历中，信息共享和关系建立是工作关系中密不可分的组成部分，这种工作关系同时具有情感、行为和工具性。反过来，这种经历又影响了女性对疾病体验的控制感和掌控感，以及她们学会与乳腺癌共存的体验。研究结果揭示了全面以患者为中心的工作关系的重要性。确定了几种增强有效沟通的具体技巧。
