de Haes Hanneke, Teunissen Saskia
Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands.
Curr Opin Oncol. 2005 Jul;17(4):345-50. doi: 10.1097/01.cco.0000167735.26454.79.
The quality of communication with patients, family, and team members is an extremely important element in palliative cancer care. The current paper reviews the literature on these topics as published in 2004.
Trust was found to be a major factor for relationship building. Information gathered by patient self-report is the method of choice, given improved insight in symptom prevalence, duration, frequency, and interference. Cultural factors in information giving, the optimal process and content, and the difficulty of conveying hope were addressed. Decision making in palliative care requires a complex integration of conceptual knowledge, ethical and legal implications, and communication skills. Aspects of manageability are explored. Although health care providers must communicate about emotions, the existential distress of cancer patients and carers often goes overlooked in the last phases of life.
Themes included the education of health care providers, the need to care for carers, and interdisciplinary communication. Little attention was given to the growing population of elderly patients. Observer-based studies are unfortunately scarce, making the practice of palliative communication unseen. Finally, few studies report the cost-effectiveness of palliative care interventions though such studies may enhance palliative care and convince policy makers of the need to support such care. More empirical work is needed to improve the level of quality needed to ensure a good remaining lifetime for cancer patients whose disease cannot be cured.
与患者、家属及团队成员的沟通质量是癌症姑息治疗中极为重要的因素。本文综述了2004年发表的关于这些主题的文献。
信任是建立关系的主要因素。鉴于患者自我报告收集的信息能更好地洞察症状的发生率、持续时间、频率及干扰情况，它是首选方法。探讨了信息提供中的文化因素、最佳流程和内容以及传递希望的困难。姑息治疗中的决策需要综合概念知识、伦理和法律影响以及沟通技巧。还探讨了可管理性的各个方面。尽管医疗保健提供者必须就情感进行沟通，但癌症患者和护理人员的生存困扰在生命的最后阶段常常被忽视。
主题包括医疗保健提供者的教育、照顾护理人员的必要性以及跨学科沟通。对老年患者不断增加的群体关注较少。遗憾的是，基于观察的研究很少，使得姑息沟通的实践难以看到。最后，很少有研究报告姑息治疗干预措施的成本效益，尽管此类研究可能会加强姑息治疗并使政策制定者相信支持此类治疗的必要性。需要更多的实证研究来提高质量水平，以确保无法治愈疾病的癌症患者有良好的剩余生存期。
