Detmar S B, Muller M J, Wever L D, Schornagel J H, Aaronson N K
Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
JAMA. 2001 Mar 14;285(10):1351-7. doi: 10.1001/jama.285.10.1351.
Improving health-related quality of life (HRQL) is an important goal of palliative treatment, but little is known about actual patient-physician communication regarding HRQL topics during palliative treatment.
To investigate the content of routine communication regarding 4 specific HRQL issues between oncologists and their patients and to identify patient-, physician-, and visit-specific factors significantly associated with discussion of such issues.
Observational study conducted between June 1996 and January 1998.
Outpatient palliative chemotherapy clinic of a cancer hospital in the Netherlands.
Ten oncologists and 240 of their patients (72% female; mean age, 55 years) who had incurable cancer and were receiving outpatient palliative chemotherapy.
Patient and physician questionnaires and audiotape analysis of communication regarding daily activities, emotional functioning, pain, and fatigue during an outpatient consultation using the Roter Interaction Analysis System.
Physicians devoted 64% of their conversation to medical/technical issues and 23% to HRQL issues. Patients' communication behavior was divided more equally between medical/technical issues (41%) and HRQL topics (48%). Of the independent variables investigated, patients' self-reported HRQL was the most powerful predictor of discussing HRQL issues. Nevertheless, in 20% to 54% of the consultations in which patients were experiencing serious HRQL problems, no time was devoted to discussion of those problems. In particular, these patients' emotional functioning and fatigue were unaddressed 54% and 48% of the time, respectively. Discussion of HRQL issues was not more frequent in consultations in which tumor response was evaluated.
Despite increasing recognition of the importance of maintaining patients' HRQL as a goal of palliative treatment, the amount of patient-physician communication devoted to such issues remains limited and appears to make only a modest contribution, at least in an explicit sense, to the evaluation of treatment efficacy in daily clinical practice.
改善与健康相关的生活质量（HRQL）是姑息治疗的一个重要目标，但对于姑息治疗期间医患之间就HRQL主题的实际沟通情况却知之甚少。
调查肿瘤学家与其患者之间就4个特定HRQL问题进行的常规沟通内容，并确定与这些问题讨论显著相关的患者、医生和就诊相关因素。
1996年6月至1998年1月进行的观察性研究。
荷兰一家癌症医院的门诊姑息化疗诊所。
10名肿瘤学家及其240名患者（72%为女性；平均年龄55岁），这些患者患有无法治愈的癌症，正在接受门诊姑息化疗。
使用罗特互动分析系统，对门诊会诊期间关于日常活动、情绪功能、疼痛和疲劳的沟通进行患者和医生问卷调查及录音分析。
医生将64%的谈话用于医疗/技术问题，23%用于HRQL问题。患者的沟通行为在医疗/技术问题（41%）和HRQL主题（48%）之间分配更为平均。在所调查的自变量中，患者自我报告的HRQL是讨论HRQL问题的最有力预测因素。然而，在20%至54%的患者存在严重HRQL问题的会诊中，没有时间讨论这些问题。特别是，这些患者的情绪功能和疲劳分别有54%和48%的时间未得到讨论。在评估肿瘤反应的会诊中，关于HRQL问题的讨论并不更频繁。
尽管越来越认识到将维持患者的HRQL作为姑息治疗目标的重要性，但医患之间就此类问题进行的沟通量仍然有限，并且至少在明确意义上，对日常临床实践中治疗效果的评估似乎只做出了适度贡献。
