患者、陪伴者和肿瘤学家在三方肿瘤学临床互动中讨论信息的一致性。
Patient, companion, and oncologist agreement regarding information discussed during triadic oncology clinical interactions.
机构信息
Department of Oncology, Wayne State University, Detroit, MI 48201, USA.
出版信息
Psychooncology. 2013 Mar;22(3):637-45. doi: 10.1002/pon.3045. Epub 2012 Feb 15.
BACKGROUND
Although people with cancer want and need information from their oncologists, patients and oncologists often disagree about what information was discussed during clinical interactions. Most patients have companions present during oncology visits; we investigated whether companions process information more accurately than patients. Specifically, we examined whether patients and companions differed in agreement with oncologists about what was discussed. We also investigated the effect of topic on agreement and patient/companion self-reported understanding of discussions.
METHODS
Patients with companions were invited to participate on first visits to a cancer center in Detroit, MI. Patients, companions, and oncologists independently completed questionnaires immediately following visits. Participants were asked whether five topics were discussed (diagnosis, prognosis, metastasis, treatment/treatment goals, and side effects) and, if discussed, what oncologists said. Participants were also asked to estimate their own and each other's understanding of discussions.
RESULTS
A total of 66 patient-companion-oncologist triads participated. Agreement was higher regarding whether topics were discussed than what oncologists said. Agreement did not differ by dyad type. Patients, companions, and oncologists were equally likely to be the source of triadic disagreements. Agreement was high about diagnosis (>90%) but much lower about other topics, particularly side effects. Patients and companions reported greater understanding of discussions than oncologists estimated and more accurately estimated each other's understanding than did oncologists.
CONCLUSIONS
Companions and patients showed similar levels of agreement with oncologists about what they discussed during visits. Interventions are needed to improve communication of information to both patients and companions, especially about particular topics.
背景
尽管癌症患者希望并需要从肿瘤医生那里获取信息，但患者和医生在临床交流中讨论的内容往往存在分歧。大多数患者在肿瘤就诊时有同伴陪伴；我们研究了同伴是否比患者更准确地处理信息。具体来说，我们检查了患者和同伴与肿瘤医生对讨论内容的一致性是否存在差异。我们还研究了主题对一致性的影响以及患者/同伴对讨论内容理解的自我报告。
方法
在密歇根州底特律的一家癌症中心，邀请有同伴陪伴的患者参与首次就诊。患者、同伴和肿瘤医生在就诊后立即独立完成问卷调查。参与者被问及是否讨论了五个话题（诊断、预后、转移、治疗/治疗目标和副作用），以及如果讨论了，肿瘤医生说了什么。参与者还被要求估计自己和对方对讨论的理解。
结果
共有 66 个患者-同伴-肿瘤医生三人组参与了研究。关于是否讨论了话题的一致性高于对肿瘤医生所说内容的一致性。一致性与配对类型无关。患者、同伴和肿瘤医生同样有可能成为三方不一致的来源。关于诊断的一致性很高（>90%），但关于其他话题的一致性则低得多，特别是关于副作用的话题。患者和同伴报告的讨论理解程度高于肿瘤医生的估计，并且比肿瘤医生更准确地估计了彼此的理解程度。
结论
同伴和患者在与肿瘤医生讨论的内容上与肿瘤医生的一致性相似。需要采取干预措施，以改善向患者和同伴双方传递信息的方式，尤其是关于特定话题的信息传递。
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