Thorne Sally E, Hislop T Gregory, Stajduhar Kelli, Oglov Valerie
University of British Columbia School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC, Canada.
Psychooncology. 2009 May;18(5):500-7. doi: 10.1002/pon.1418.
Although it is well recognized that skilled communication is an essential element of effective cancer care, lack of time to communicate is often cited as an explanation for the ongoing cancer care communications problems patients report. In this study, we sought to answer the question: How do cancer patients describe and explain the effects of health care communication upon their experience of time?
We conducted a qualitative secondary analysis, using interpretive description methodology, on a large data set that comprised transcribed interview data from two studies of cancer communication from the patient perspective. One primary study represented a cross-sectional study of helpful and unhelpful communications (n=200) and the other a longitudinal study of changes in communication needs and preferences over the illness trajectory (n=60).
We found time a meaningful and symbolic construct for cancer patients. They describe clinician time-related attitudes and behaviors as significant factors in shaping the impact of clinical encounters on their overall psychosocial cancer experiences. They report a number of ways in which clinician communications have been particularly effective in buffering and manipulating the impact of time pressures and describe a capacity within exceptionally skilled clinicians to manufacture a perception of available time even in the context of such pressures.
We believe that the patient perspective on cancer care communication provides an important angle of vision from which to discern strategies that may assist clinicians to buffer the untoward effects of the time pressure under which most care systems currently operate.
尽管人们普遍认识到有效的沟通是癌症护理的关键要素,但患者报告的癌症护理沟通问题持续存在,常被归因于缺乏沟通时间。在本研究中,我们试图回答以下问题:癌症患者如何描述和解释医疗沟通对其时间体验的影响?
我们采用解释性描述方法,对一个大型数据集进行定性二次分析,该数据集包含两项从患者角度研究癌症沟通的访谈转录数据。一项主要研究是关于有益和无益沟通的横断面研究(n = 200),另一项是关于疾病轨迹中沟通需求和偏好变化的纵向研究(n = 60)。
我们发现时间对癌症患者来说是一个有意义且具有象征意义的概念。他们将临床医生与时间相关的态度和行为描述为塑造临床接触对其整体癌症心理社会体验影响的重要因素。他们报告了临床医生沟通在缓冲和应对时间压力影响方面特别有效的多种方式,并描述了即使在这种压力下,特别熟练的临床医生也有能力营造出时间充裕的感觉。
我们认为患者对癌症护理沟通的看法提供了一个重要视角,从中可以识别出有助于临床医生缓冲当前大多数护理系统所面临的时间压力不良影响的策略。