Wittenberg-Lyles Elaine, Goldsmith Joy, Ragan Sandra
Department of Communication Studies, University of North Texas, Denton, USA.
Clin J Oncol Nurs. 2011 Jun;15(3):304-10. doi: 10.1188/11.CJON.304-310.
For the current study, clinical observations of communication between patients, families, and clinicians during chronic, serious, or terminal illness in a cancer care trajectory were examined for patterns and trends. Five communication characteristics were concluded, which informed a typology of illness journeys experienced by patients with cancer and their families. The isolated journey characterizes an illness path in which communication about terminal prognosis and end-of-life care options are not present; communication is restricted by a curative-only approach to diagnosis as well as the structure of medical care. The rescued journey signifies a transition between curative care (hospital narrative) to noncurative care (hospice narrative), challenging patients and their families with an awareness of dying. The rescued journey allows communication about prognosis and care options, establishes productive experiences through open awareness, and affords patients and families opportunities to experience end-of-life care preferences. Finally, palliative care prior to hospice provides patients and families with an illness journey more readily characterized by open awareness and community, which facilitates a comforted journey. Nurses play a pivotal role in communicating about disease progression and plans of care. The typology presented can inform a structured communication curriculum for nurses and assist in the implementation of early palliative care.
在本研究中，对癌症护理过程中慢性、严重或终末期疾病患者、家属与临床医生之间沟通的临床观察进行了模式和趋势分析。总结出了五个沟通特征，这些特征为癌症患者及其家属所经历的疾病历程类型提供了依据。孤立型历程描述的是一种疾病路径，其中不存在关于终末期预后和临终护理选择的沟通；沟通受到仅以治愈为目的的诊断方法以及医疗护理结构的限制。拯救型历程意味着从治愈性护理（医院模式）向非治愈性护理（临终关怀模式）的转变，让患者及其家属意识到死亡。拯救型历程允许就预后和护理选择进行沟通，通过开放的认知建立有效的体验，并为患者和家属提供体验临终护理偏好的机会。最后，临终关怀之前的姑息治疗为患者和家属提供了一个更容易以开放认知和社区为特征的疾病历程，这有助于实现舒适的历程。护士在沟通疾病进展和护理计划方面发挥着关键作用。所呈现的类型学可为护士提供结构化的沟通课程，并有助于早期姑息治疗的实施。
