Street Richard L, Gordon Howard S
Department of Communication, Texas A&M University, College Station, TX 77843-4234, USA.
Psychooncology. 2008 Mar;17(3):244-51. doi: 10.1002/pon.1225.
Companions play an important role in cancer care. This investigation compared the communication of unaccompanied patients, accompanied patients, and companions during lung cancer consultations. Factors affecting the active participation of companions were analyzed.
Participants included unaccompanied patients (N=48), accompanied patients (N=84), and companions (N=84) of newly diagnosed lung cancer patients seen at a large southern VA medical center. The consultations were audiotaped, then transcribed. Coded utterances included patients' and companions' active participation (asking questions, expressing concerns, and making assertions) and physicians' use of facilitative communication. Mixed linear regression was used for comparisons of accompanied patients' participation to that of their companions and to determine the independent predictors of companion participation and patient satisfaction.
The combined companion plus patient participation did not differ from the participation of unaccompanied patients. Patterns of companion participation varied greatly as almost half the interactions had a relatively passive companion (contributed to less than 40% of the patient plus companion active participation) but 33% of the consultations had an active companion and passive patient. Companions with less active participation accompanied black patients and received proportionally less facilitative communication from physicians. Patient satisfaction was lower when companion and patient had similar levels of participation.
Companions vary greatly in their participation in lung cancer visits. Physicians facilitate companion participation through the use of partnership-building and supportive communication. The companions of black patients were less active than their white counterparts which parallels other research indicating that black patients are often less active than white patients. Such communicative discrepancies could contribute to racial disparities in cancer care.
陪伴者在癌症护理中发挥着重要作用。本研究比较了无人陪伴患者、有陪伴患者及其陪伴者在肺癌会诊过程中的沟通情况。分析了影响陪伴者积极参与的因素。
参与者包括在南方一家大型退伍军人医疗中心就诊的新诊断肺癌患者中的无人陪伴患者（N = 48）、有陪伴患者（N = 84）及其陪伴者（N = 84）。会诊过程进行录音，然后转录。编码话语包括患者和陪伴者的积极参与（提问、表达担忧和发表断言）以及医生使用的促进性沟通。采用混合线性回归比较有陪伴患者与其陪伴者的参与情况，并确定陪伴者参与和患者满意度的独立预测因素。
陪伴者加患者的总参与度与无人陪伴患者的参与度没有差异。陪伴者的参与模式差异很大，几乎一半的互动中陪伴者相对被动（在患者加陪伴者的积极参与中占比不到40%），但33%的会诊中陪伴者积极而患者被动。参与度较低的陪伴者陪伴黑人患者，且从医生那里获得的促进性沟通相对较少。当陪伴者和患者的参与程度相似时，患者满意度较低。
陪伴者在肺癌就诊中的参与程度差异很大。医生通过建立伙伴关系和支持性沟通来促进陪伴者的参与。黑人患者的陪伴者比白人患者的陪伴者活跃度更低，这与其他研究表明黑人患者通常比白人患者活跃度更低相一致。这种沟通差异可能导致癌症护理中的种族差异。
