Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, Fallon Community Health Plan, Worcester, MA, USA.
Psychooncology. 2013 Nov;22(11):2487-95. doi: 10.1002/pon.3317. Epub 2013 Jun 18.
To explore patients' and family members' views on communication during cancer care and to identify those aspects of clinician-patient communication which were most important to patients and family members.
We conducted a secondary data analysis of qualitative data from 137 patients with cancer and family members of patients with cancer. We used a modified version of the constant comparative method and coding paradigm of grounded theory.
Patients want sensitive, caring clinicians who provide information that they need, when they need it, in a way that they can understand; who listen and respond to questions and concerns, and who attempt to understand the patient's experience. Effective information exchange and a positive interpersonal relationship with the clinician were of fundamental importance to patients and family members. These were interrelated; for instance, failure to provide information a patient needed could damage the relationship, whereas excellent listening could foster the relationship. Information exchange and relationship were also integral to decision-making, managing uncertainty, responding to emotions, and self-management. Clinicians who were responsive to patients' needs beyond the immediate medical encounter were valued.
The complexity of cancer care today suggests that efforts to improve communication must be multilevel, acknowledging and addressing patient, clinician, organizational and policy barriers, and facilitators. Measurement tools are needed to assess cancer patients' and family members' experiences with communication over the course of cancer care to provide meaningful, actionable feedback to those seeking to optimize their effectiveness in communicating with patients with cancer.
探讨癌症患者及其家属对癌症护理过程中沟通的看法，并确定患者及其家属认为临床医生与患者沟通中最重要的方面。
我们对 137 名癌症患者及其家属的定性数据进行了二次数据分析。我们使用了扎根理论的常数比较法和编码范式的改良版本。
患者希望临床医生具有敏感性和关爱性，能够在他们需要的时候，以他们能够理解的方式提供所需的信息；倾听并回应问题和关注点，并试图理解患者的经历。有效的信息交流和与临床医生的积极人际关系对患者和家属至关重要。这些是相互关联的；例如，未能提供患者所需的信息可能会破坏关系，而出色的倾听则可以促进关系。信息交流和关系也是决策、管理不确定性、应对情绪和自我管理的基础。对患者的需求做出反应超出了直接医疗接触的临床医生受到重视。
当今癌症护理的复杂性表明，必须从多个层面努力改善沟通，承认和解决患者、临床医生、组织和政策障碍以及促进因素。需要测量工具来评估癌症患者及其家属在癌症护理过程中沟通的体验，为那些试图优化与癌症患者沟通效果的人提供有意义的、可操作的反馈。
