Wuensch Alexander, Tang Lilli, Goelz Tanja, Zhang Yening, Stubenrauch Sara, Song Lili, Hong Ye, Zhang Haiwei, Wirsching Michael, Fritzsche Kurt
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Freiburg, Germany.
Psychooncology. 2013 May;22(5):1192-5. doi: 10.1002/pon.3112. Epub 2012 May 27.
Current practice of breaking bad news in China involves disclosure of information first to family members who then decide whether the patient should receive this information. Recently, however, patients' right to be informed has been regulated by law. This represents a dilemma for oncologists who now have to balance traditional practice with new legal requirements. A communication skills training (CST) was developed for Chinese practice. It addresses this issue and may help participants find individual solutions within these conflicting requirements.
A first CST about breaking bad news took place at the Beijing Cancer Hospital, China, with 31 participants. We (i) assessed current practice, (ii) evaluated the workshop and (iii) self-assessed performance ratings about breaking bad news before and after the workshop with the help of questionnaires.
(i) Participants stated that in most cases (78%), they inform family members first. Contrary to this practice, participants think that about 75% of patients would like to be informed first, independent of family. (ii) Overall, the workshop received a very good rating (M = 1.2; scale between 1 and 6). (iii) After the workshop, the participants rated their performance significantly higher in all areas, for example, talking about diagnosis, prognosis and death with the patient and the family.
The CST showed high acceptance and led to significantly improved performance ratings of participating physicians in many areas. It helped participants deal with conflicting demands. For future trainings, further socio-cultural adaptations are needed. Obvious conflicts still exist and need to be resolved.
目前中国告知坏消息的做法是先向家庭成员披露信息，然后由他们决定患者是否应该得知此信息。然而，最近患者的知情权已受法律规范。这给肿瘤学家带来了两难困境，他们现在必须在传统做法和新的法律要求之间取得平衡。针对中国的实际情况开发了一种沟通技能培训（CST）。它解决了这个问题，并可能帮助参与者在这些相互冲突的要求中找到个人解决方案。
在中国北京肿瘤医院举办了首次关于告知坏消息的CST，有31名参与者。我们（i）评估了当前的做法，（ii）评估了研讨会，（iii）借助问卷在研讨会前后对告知坏消息的表现评级进行了自我评估。
（i）参与者表示，在大多数情况下（78%），他们先告知家庭成员。与这种做法相反，参与者认为约75%的患者希望先得知消息，而不依赖家人。（ii）总体而言，研讨会获得了非常好的评价（M = 1.2；评分范围为1至6）。（iii）研讨会后，参与者在所有领域对自己表现的评级都显著提高，例如，与患者及其家人谈论诊断、预后和死亡情况。
CST显示出高度的接受度，并使参与培训的医生在许多领域的表现评级显著提高。它帮助参与者应对相互冲突的要求。对于未来的培训，需要进一步进行社会文化方面的调整。明显的冲突仍然存在，需要加以解决。
