Barnett Mandy M
Centre for Primary Health Care Studies, University of Warwick, Coventry CV4 7AL, UK.
J R Soc Med. 2002 Jul;95(7):343-7. doi: 10.1177/014107680209500706.
The breaking of bad news is a routine but difficult task for many health professionals. There are numerous anecdotes of insensitive practice but the subject has attracted little systematic research. We therefore interviewed 106 patients with advanced cancer (from an original sample of 195) to assess their perceptions of the doctors involved in their care. Aspects of the 'breaking bad news' event were recorded during discussion of the illness history and were subsequently rated. Participants were also asked to nominate doctors under the headings 'most helpful' and 'less helpful', and completed standardized psychological screening questionnaires. In 94 of the 106 cases the bad news had been given by a doctor, usually a surgeon. Of the 13 doctors categorized as 'most helpful' when breaking bad news, 8 were general practitioners; of the 7 categorized as 'less helpful' all were surgeons. 69% of patients were neutral or positive about the bad-news consultation, but 20% were negative and 6% very negative. Doctors in surgical specialties were significantly more likely to be rated poorly than non-surgical specialists or general practitioners. Surgeons were the group of doctors most likely to break bad news, but non-surgical doctors were rated more positively in performance of the task. This finding has implications for training.
对许多医疗专业人员来说，传达坏消息是一项常规但困难的任务。有许多关于麻木不仁做法的轶事，但这个主题几乎没有吸引到系统的研究。因此，我们采访了106名晚期癌症患者（原始样本为195名），以评估他们对参与其治疗的医生的看法。在讨论病史期间记录了“传达坏消息”事件的各个方面，并随后进行了评分。参与者还被要求在“最有帮助”和“帮助较小”的标题下列出医生，并完成标准化的心理筛查问卷。在106个案例中的94个案例中，坏消息是由医生传达的，通常是外科医生。在传达坏消息时被归类为“最有帮助”的13名医生中，有8名是全科医生；在被归类为“帮助较小”的7名医生中，全部是外科医生。69%的患者对坏消息咨询持中立或积极态度，但20%的患者持消极态度，6%的患者持非常消极的态度。外科专科医生比非外科专科医生或全科医生更有可能被评为较差。外科医生是最有可能传达坏消息的医生群体，但非外科医生在这项任务中的表现得到了更积极的评价。这一发现对培训有启示意义。
