Hines S C, Babrow A S, Badzek L, Moss A
Delmarue Foundation, Easton, Maryland 21661, USA. hinesstddfmc.org
Health Commun. 2001;13(3):327-42. doi: 10.1207/S15327027HC1303_6.
Decisions made by and for elderly patients nearing death frequently perpetuate unwanted suffering and dependence. This article extends the argument that Babrow's (1992, 1995) problematic integration theory can provide insights into why communication fails to produce desired outcomes for such patients. Open-ended responses obtained in face-to-face interviews with 142 elderly dialysis patients and mailed surveys of 393 dialysis unit nurses were examined to better understand how patients and nurses reconciled incompatible probabilistic and evaluativejudgments. Results indicate that patients seek information that will enable them to cope with debilitating dialysis treatments rather than information nurses believe is necessary for them to make informed choices about whether to undergo such treatments. The tension between the information patients want to successfully cope with life and the information they need to decide intelligently about treatments that forestall death constitutes a key reason why communication about end-of-life issues is frequently flawed. Our analysis of these communication flaws leads to specific recommendations for how this tension can be eased, which in turn may better prepare patients to make the transition from coping with life to coping with death.
为濒死老年患者做出的决策往往会使不必要的痛苦和依赖持续存在。本文进一步论证了巴布罗（1992年、1995年）的问题整合理论能够为理解为何沟通未能为这类患者带来预期结果提供见解。对142名老年透析患者进行面对面访谈以及对393名透析科室护士进行邮寄调查所获得的开放式回答进行了研究，以更好地了解患者和护士是如何协调不相容的概率性判断和评估性判断的。结果表明，患者寻求的是能够让他们应对使人衰弱的透析治疗的信息，而非护士认为他们做出是否接受此类治疗的明智选择所必需的信息。患者想要成功应对生活所需的信息与他们明智决定延缓死亡的治疗所需的信息之间的紧张关系，是临终问题沟通经常存在缺陷的一个关键原因。我们对这些沟通缺陷的分析得出了关于如何缓解这种紧张关系的具体建议，这反过来可能会让患者更好地做好从应对生活过渡到应对死亡的准备。
