Wenrich M D, Curtis J R, Shannon S E, Carline J D, Ambrozy D M, Ramsey P G
Office of the Vice President for Medical Affairs and Dean of the School of Medicine, University of Washington, Campus Box 356350, Seattle, WA 98195-6350, USA.
Arch Intern Med. 2001 Mar 26;161(6):868-74. doi: 10.1001/archinte.161.6.868.
Efforts to improve communication between physicians and dying patients have been unsuccessful, and guidelines for improving patient-physician communication about end-of-life care are based primarily on expert opinion. This study assessed which aspects of communication between patients and physicians are important in end-of-life care.
Twenty focus groups were held with 137 individuals, including patients with chronic and terminal illnesses, family members, health care professionals from hospice or acute care settings, and physicians with expertise in end-of-life care. Focus group analyses determined domains of physician skill at end-of-life care. Communication with patients was identified as one of the most important domains. Analyses of components important in communicating with dying patients and their families were performed.
The following 6 areas were of central importance in communicating with dying patients: talking with patients in an honest and straightforward way, being willing to talk about dying, giving bad news in a sensitive way, listening to patients, encouraging questions from patients, and being sensitive to when patients are ready to talk about death. Within these components, subthemes emerged that provide guidelines for physicians and educators. Dying patients also identified the need to achieve a balance between being honest and straightforward and not discouraging hope.
Several areas emerged for physicians to focus their attention on when communicating with dying patients. These findings provide guidance in how to improve this communication. They also highlight the need to approach communication about end-of-life care as a spectrum that requires attention from the time of a terminal diagnosis through death.
改善医生与临终患者之间沟通的努力一直未取得成功，关于改善临终关怀中患者与医生沟通的指南主要基于专家意见。本研究评估了患者与医生沟通的哪些方面在临终关怀中很重要。
对137人进行了20次焦点小组访谈，其中包括患有慢性和晚期疾病的患者、家庭成员、临终关怀或急症护理机构的医护人员以及在临终关怀方面有专长的医生。焦点小组分析确定了临终关怀中医师技能的领域。与患者的沟通被确定为最重要的领域之一。对与临终患者及其家属沟通中重要的组成部分进行了分析。
在与临终患者沟通时，以下6个方面至关重要：以诚实和直接的方式与患者交谈、愿意谈论死亡、以敏感的方式告知坏消息、倾听患者、鼓励患者提问以及对患者何时准备好谈论死亡保持敏感。在这些组成部分中，出现了一些子主题，为医生和教育工作者提供了指导方针。临终患者还指出，需要在诚实直接和不打击希望之间取得平衡。
医生在与临终患者沟通时出现了几个需要关注的领域。这些发现为如何改善这种沟通提供了指导。它们还强调了将临终关怀沟通视为一个连续过程的必要性，从晚期诊断之时到死亡都需要关注。
