Tasaki Katsuya, Maskarinec Gertraud, Shumay Dianne M, Tatsumura Yvonne, Kakai Hisako
Cancer Research Center of Hawaii, Honolulu, HI 96813, USA.
Psychooncology. 2002 May-Jun;11(3):212-20. doi: 10.1002/pon.552.
The aim of this paper is to identify barriers to communication between physicians and cancer patients regarding complementary and alternative medicine (CAM) by exploring the perspectives of patients. In face of the recent popularity of CAM use among cancer patients, the lack of communication is a serious problem. A number of CAM therapies may interfere with conventional treatments and thus impact patients' well-being and chances of survival. In addition, lack of communication is problematic in the health care context because the development of openness and trust between health care providers and clients is contingent upon effective interpersonal communication. We conducted semi-structured interviews with 143 cancer patients to explore their experiences with CAM use. Using a qualitative research method, we examined interview data from 93 CAM users who provided sufficient information about communication issues. As a result, three themes emerged describing barriers to unsuccessful communication as perceived from the patient's point of view: physicians' indifference or opposition toward CAM use, physicians' emphasis on scientific evidence, and patients' anticipation of a negative response from their physician. Increasing education about CAM and regular assessment of CAM use may help physicians to be more aware of their patients' CAM use. As a result, physicians may provide patients with information on risks and benefits of CAM use and refer patients to other services that may address unmet needs. Given a difference in epistemiologic beliefs about cancer and its treatment, the challenge is to find a common ground for an open discussion in which physicians consider that scientific evidence is not all that counts in the life of an individual facing a serious disease.
本文旨在通过探究患者的观点，找出医生与癌症患者在补充和替代医学（CAM）方面沟通的障碍。鉴于最近补充和替代医学在癌症患者中使用的普及，沟通不足是一个严重问题。一些补充和替代医学疗法可能会干扰传统治疗，从而影响患者的健康和生存几率。此外，在医疗保健环境中，沟通不足也是个问题，因为医疗保健提供者与患者之间开放和信任的建立取决于有效的人际沟通。我们对143名癌症患者进行了半结构化访谈，以探究他们使用补充和替代医学的经历。我们采用定性研究方法，研究了93名提供了足够沟通问题信息的补充和替代医学使用者的访谈数据。结果出现了三个主题，描述了从患者角度看沟通不成功的障碍：医生对使用补充和替代医学的冷漠或反对、医生对科学证据的强调以及患者预期医生会给出负面回应。增加对补充和替代医学的教育以及定期评估补充和替代医学的使用，可能有助于医生更了解患者对补充和替代医学的使用情况。因此，医生可以向患者提供补充和替代医学使用的风险和益处信息，并将患者转介到其他可能满足未满足需求的服务机构。鉴于在癌症及其治疗的认识论信念上存在差异，挑战在于找到一个进行开放讨论的共同点，在这个讨论中，医生要认识到对于面临严重疾病的个人来说，科学证据并非一切。
