肺癌沟通中错失的共情时机。
Missed opportunities for interval empathy in lung cancer communication.
作者信息
Morse Diane S, Edwardsen Elizabeth A, Gordon Howard S
机构信息
University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. Diane_mors,
出版信息
Arch Intern Med. 2008 Sep 22;168(17):1853-8. doi: 10.1001/archinte.168.17.1853.
BACKGROUND
Empathy is important in patient-physician communication and is associated with improved patient satisfaction and adherence to physicians' recommendations.
METHODS
To evaluate empathic opportunities and physician responses, we conducted a qualitative thematic analysis of 20 audiorecorded, transcribed consultations between patients with lung cancer and their thoracic surgeons or oncologists, from a larger observational study of 137 patients in a Veterans Affairs hospital in the southern United States. Using qualitative analysis, we collaboratively developed themes and subthemes until saturation. Then, each transcript was coded, using grounded theory methods, until consensus was achieved, counting and sequentially analyzing patient empathic opportunities and physician responses.
RESULTS
Subthemes regarding patients' statements about lung cancer included (1) morbidity or mortality concerns, (2) cancer-related symptoms, (3) relationship to smoking, (4) decisions about treatment, (5) beliefs about or mistrust of medical care, (6) factors limiting ability to treat cancer, and (7) confusion regarding cancer status and treatment. We identified 384 empathic opportunities and found that physicians had responded empathically to 39 (10%) of them. Otherwise, physicians provided little emotional support, often shifting to biomedical questions and statements. We defined this phenomenon as missed opportunities for "interval empathy." When empathy was provided, 50% of these statements occurred in the last one-third of the encounter, whereas patients' concerns were evenly raised throughout the encounter.
CONCLUSIONS
Physicians rarely responded empathically to the concerns raised by patients with lung cancer, and empathic responses that did occur were more frequently in the last third of the encounter. Our results may provide a typologic approach to help physicians recognize empathic opportunities and with further development may aid in improving physicians' communication skills.
背景
同理心在医患沟通中很重要，并且与患者满意度提高以及对医生建议的依从性相关。
方法
为了评估同理心机会和医生的反应，我们对20份肺癌患者与其胸外科医生或肿瘤内科医生之间的会诊录音及转录文本进行了定性主题分析，这些文本来自美国南部一家退伍军人事务医院对137名患者进行的一项更大规模的观察性研究。通过定性分析，我们共同制定主题和子主题，直至达到饱和状态。然后，使用扎根理论方法对每份文本进行编码，直至达成共识，同时计算并依次分析患者的同理心机会和医生的反应。
结果
关于患者对肺癌陈述的子主题包括：（1）对发病率或死亡率的担忧；（2）癌症相关症状；（3）与吸烟的关系；（4）治疗决策；（5）对医疗护理的看法或不信任；（6）限制癌症治疗能力的因素；（7）对癌症状况和治疗的困惑。我们识别出384个同理心机会，发现医生对其中39个（10%）做出了同理心反应。否则，医生很少提供情感支持，常常转向生物医学问题和陈述。我们将这种现象定义为“间隔同理心”的错失机会。当提供同理心时，这些陈述中有50%出现在会诊的最后三分之一时间内，而患者的担忧在整个会诊过程中是均匀出现的。
结论
医生很少对肺癌患者提出的担忧做出同理心反应，而确实出现的同理心反应更频繁地出现在会诊的最后三分之一时间内。我们的结果可能提供一种类型学方法，以帮助医生识别同理心机会，并且随着进一步发展可能有助于提高医生的沟通技巧。
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