Rodriguez Keri L, Gambino Frank J, Butow Phyllis N, Hagerty Rebecca G, Arnold Robert M
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240-1000, USA.
Psychooncology. 2008 Mar;17(3):219-25. doi: 10.1002/pon.1223.
In this qualitative study, we used grounded theory techniques to analyze transcripts of 29 first-time encounters between oncologists and patients referred to them with previously diagnosed, incurable cancer. We found that 23 (79%) of the transcripts included 166 examples of prognostic talk. The language used ranged from general to personal, with 25% of statements mentioning no patients (e.g., 'the tumor will usually come back'), 13% mentioning patients other than the current patient (e.g., 'some patients with tumor response will be around for 2-5 years'), 11% mentioning the current patient in the context of others (e.g., 'on average, people like you live a couple of years'), and 51% directly focusing on the patient (e.g., 'this thing's going to kill you eventually'). More statements pertained to treatment-related prognosis than to disease-related prognosis (67 versus 33%). While 31% of statements focused on negative outcomes (loss framing), the remainder either focused on positive outcomes (gain framing) or discussed a combination of positive and negative outcomes (mixed framing). When discussions focused on negative outcomes, general and indirect language was commonly used, perhaps to buffer the patient from news of the poor prognosis.
在这项定性研究中，我们运用扎根理论技术分析了肿瘤学家与被转诊来的、此前已被诊断为不治之症的癌症患者之间29次首次会面的记录。我们发现，23份（79%）记录中包含166个预后讨论的例子。所使用的语言从笼统到具体，其中25%的陈述未提及任何患者（例如，“肿瘤通常会复发”），13%提及了当前患者以外的患者（例如，“一些有肿瘤反应的患者能活2至5年”），11%在提及其他患者的背景下提到了当前患者（例如，“像你这样的人平均能活几年”），51%直接聚焦于患者（例如，“这病最终会要了你的命”）。与疾病相关的预后相比，更多陈述涉及与治疗相关的预后（67%对33%）。虽然31%的陈述聚焦于负面结果（损失框架），其余陈述要么聚焦于正面结果（获益框架），要么讨论了正面和负面结果的组合（混合框架）。当讨论聚焦于负面结果时，通常会使用笼统和间接的语言，这可能是为了让患者免受预后不良消息的冲击。
