Little Miles, Jordens Christopher F C, McGrath Catherine, Montgomery Kathleen, Kerridge Ian, Carter Stacy M
Centre for Values, Ethics and the Law in Medicine Sydney, University of Sydney, NSW, Australia.
Soc Sci Med. 2007 Apr;64(7):1512-23. doi: 10.1016/j.socscimed.2006.11.017. Epub 2006 Dec 22.
High-dose chemotherapy and autologous stem cell transplantation (ASCT) is used to treat some advanced malignancies. It is a traumatic procedure, with a high complication rate and significant mortality. ASCT patients and their carers draw on many sources of information as they seek to understand the procedure and its consequences. Some seek information from beyond orthodox medicine. Alternative beliefs and practices may conflict with conventional understanding of the theory and practice of ASCT, and 'contested understandings' might interfere with patient adherence to the strict and demanding protocols required for successful ASCT. The present study, conducted in Sydney, Australia, examines narrative-style interviews with 10 sequentially recruited ASCT patients and nine of their carers conducted at the time of transplant and three months later. Transcripts were read for instances of mention of alternative advice, and for instances of contested understanding of information relevant to the transplant. Patients and carer pairs expressed closely concordant views about alternative advice. Five pairs were consulting alternative practitioners. Contested understanding was expressed in four domains--understandings of the transplant itself and its underlying theory, of the relationship between the components of the 'transplant', of the nature and role of stem cells, and of beliefs about bodily function and life-style. Contested understandings of the transplant treatment were expressed as predominantly personal interpretations of orthodox information. Patients and carers seemed to recognise that alternative and conventional systems were discordant, yet they were able to separate the two, and adhere to each practice without prejudicing their medical treatment. A single case of late, post-transplant repudiation of Western medicine is discussed to emphasise some of the possible determinants of dissonance when it does occur.
大剂量化疗和自体干细胞移植（ASCT）被用于治疗一些晚期恶性肿瘤。这是一个创伤性的治疗过程，并发症发生率高，死亡率显著。ASCT患者及其护理人员在试图了解该治疗过程及其后果时，会利用多种信息来源。一些人会从正统医学之外寻求信息。另类的观念和做法可能与对ASCT理论和实践的传统理解相冲突，而“有争议的理解”可能会干扰患者对成功进行ASCT所需的严格且苛刻的治疗方案的依从性。本研究在澳大利亚悉尼进行，考察了对10名依次招募的ASCT患者及其9名护理人员在移植时和三个月后进行的叙事式访谈。阅读访谈记录，查找提及另类建议的情况，以及对与移植相关信息的有争议的理解情况。患者和护理人员对另类建议表达了高度一致的看法。五对患者和护理人员正在咨询另类从业者。在四个领域表达了有争议的理解——对移植本身及其基础理论的理解、对“移植”各组成部分之间关系的理解、对干细胞的性质和作用的理解，以及对身体功能和生活方式的信念。对移植治疗的有争议的理解主要表现为对正统信息的个人解读。患者和护理人员似乎认识到另类和传统体系不一致，但他们能够将两者区分开来，坚持每种做法而不影响他们的医疗治疗。讨论了一个移植后晚期拒绝西医的案例，以强调这种不一致确实发生时的一些可能决定因素。
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