Liesbeth M. van Vliet and Jozien M. Bensing, Netherlands Institute for Health Services Research (NIVEL); Elsken van der Wall, Nicole M. Plum, and Jozien M. Bensing, Utrecht University, Utrecht, the Netherlands.
J Clin Oncol. 2013 Sep 10;31(26):3242-9. doi: 10.1200/JCO.2012.45.5865. Epub 2013 Aug 12.
When discussing the transition to palliative care for patients with breast cancer, oncologists have to find a balance between giving explicit information while not overwhelming patients and being realistic while remaining hopeful. It is unclear whether patients prefer more or less explicit prognostic information, and reassuring patients that they will not be abandoned may provide realistic hope. We assessed the effect of explicit prognostic information and reassurance about nonabandonment at the transition to palliative care.
An experimental 2 × 2 study was used. Four scripted videos of a bad news conversation were created that differed only in the level of "explicitness of prognosis" and "reassurance about nonabandonment" (high v low). Patients with and survivors of breast cancer (n = 51) and healthy women (n = 53) watched the video-vignettes. The effects of the different communications on participants' anxiety, uncertainty, self-efficacy, and satisfaction were assessed by using multilevel analyses that explored the moderating influences of monitoring/blunting scores.
The highly explicit/highly reassuring video yielded the most positive outcomes, and the less explicit/less reassuring video, the most negative (P ≤ .05 for all outcome measures except anxiety). The main effects found were that explicitness and reassurance decreased participants' uncertainty (P < .001 and P = .002, respectively) and anxiety (only after reassurance; P = .001) while increasing self-efficacy (P = .004 and P < .001, respectively) and satisfaction (P < .001 and P < .001, respectively). High monitors seemed least positive, mainly following explicitness.
Explicit prognostic information may lead to better outcomes than general information. In addition, reassurance about nonabandonment might provide realistic hope but should be lived up to. More research is needed to translate these findings into clinical care.
在讨论乳腺癌患者向姑息治疗过渡时，肿瘤医生必须在提供明确信息而不使患者感到不知所措和保持现实但抱有希望之间找到平衡。目前尚不清楚患者是更喜欢还是更少明确的预后信息，而向患者保证他们不会被抛弃可能会提供现实的希望。我们评估了在向姑息治疗过渡时明确的预后信息和不放弃的保证对患者的影响。
采用实验性 2×2 研究。仅在“预后的明确程度”和“不放弃的保证”（高与低）方面有所不同，创建了 4 个坏消息对话的脚本视频。患有乳腺癌和幸存者（n=51）以及健康女性（n=53）观看了视频短片。通过使用多层次分析来评估不同沟通方式对参与者焦虑、不确定性、自我效能和满意度的影响，探讨监测/钝化评分的调节影响。
高度明确/高度保证的视频产生了最积极的结果，而不那么明确/不那么保证的视频则产生了最消极的结果（除了焦虑之外，所有结果衡量标准的 P≤0.05）。主要发现是明确性和保证降低了参与者的不确定性（P<0.001 和 P=0.002，分别）和焦虑（仅在保证后；P=0.001），同时增加了自我效能（P=0.004 和 P<0.001，分别）和满意度（P<0.001 和 P<0.001，分别）。高监测者似乎最不积极，主要是在明确性之后。
明确的预后信息可能比一般信息产生更好的结果。此外，不放弃的保证可能提供现实的希望，但应兑现。需要进一步研究将这些发现转化为临床护理。
