Bouleuc C, Bredart A, Dolbeault S, Ganem G, Copel L
Unité mobile d'accompagnement, Institut Curie, Paris, France.
Bull Cancer. 2010 Oct;97(10):1173-81. doi: 10.1684/bdc.2010.1195.
The medical information becomes integrated into a communications strategy, the generally admitted model of which is centered on the patient; that is in the listening of these concerns and these values. The medical quality information is facilitated by the preliminary collection of the symptoms and the needs of the patients thanks to the questionnaires of quality of life, if they are used during the consultation to direct the discussion. Satisfactory medical information includes a discussion about the questions of the patients in terms of outcomes. Patient's individual factors can influence the need of medical information, as the age and the pathology. Patient's needs can also vary with time and according to the phase of the disease. Cultural factors are essential, in particular as regards the information about prognosis. Tools to help giving the medical information are now validated as the audio cassettes or video. Those tools can take the shape of a prompt list to help patients to ask questions. The majority preference of style of participation in the medical and therapeutic decisions and is the collaborative mode. Physician's attitude is determinant to leave the patients who wish it to have an active role, what allows them a very beneficial feeling psychologically of control over the disease. Decision-making helps are successfully sometimes elaborated to support the participation of the patients. In palliative phase, the need of medical information about prognosis associated with preservation of hope is not still understood by physicians who oscillate between saying the all or none. Honest information at the right time is the majority wish of the patients, although certain patients adopt clearly a strategy of avoidance. The medical communication requires a specific training on this subject. Talking time must be opened to the doctors to approach the relational problems which they meet. The clinical research has to continue to understand better the interactions in doctors/patients communication.
医疗信息被整合到一种沟通策略中,其普遍认可的模式以患者为中心;也就是说要倾听患者的这些关切和价值观。如果在会诊期间使用生活质量问卷来引导讨论,通过初步收集患者的症状和需求,医疗质量信息会得到促进。令人满意的医疗信息包括就患者关于治疗结果的问题进行讨论。患者的个体因素,如年龄和病情,会影响对医疗信息的需求。患者的需求也会随时间以及疾病阶段而变化。文化因素至关重要,尤其是在关于预后的信息方面。现在一些帮助提供医疗信息的工具已得到验证,如录音带或视频。这些工具可以采用提示清单的形式来帮助患者提问。在医疗和治疗决策中,大多数人偏好的参与方式是合作模式。医生的态度对于让希望积极参与的患者发挥积极作用起着决定性作用,这能让他们在心理上产生对疾病的有益掌控感。有时会成功制定决策辅助措施来支持患者的参与。在姑息治疗阶段,医生对于在告知预后信息与保留希望之间摇摆不定,仍未理解患者对与保留希望相关的预后医疗信息的需求。及时提供诚实的信息是患者的主要愿望,尽管某些患者明显采取回避策略。医疗沟通需要针对这一主题进行专门培训。必须为医生留出谈话时间,以探讨他们遇到的人际关系问题。临床研究必须继续更好地理解医患沟通中的互动情况。