Henry Stephen G, Czarnecki Danielle, Kahn Valerie C, Chou Wen-Ying Sylvia, Fagerlin Angela, Ubel Peter A, Rovner David R, Alexander Stewart C, Knight Sara J, Holmes-Rovner Margaret
Division of General Medicine, Geriatrics, and Bioethics, University of California Davis, Sacramento, CA, USA.
Department of Sociology, University of Michigan, Ann Arbor, MI, USA.
Health Expect. 2015 Oct;18(5):1757-68. doi: 10.1111/hex.12168. Epub 2013 Dec 22.
We know little about patient-physician communication during visits to discuss diagnosis and treatment of prostate cancer.
To examine the overall visit structure and how patients and physicians transition between communication activities during visits in which patients received new prostate cancer diagnoses.
Forty veterans and 18 urologists at one VA medical centre.
We coded 40 transcripts to identify major communication activities during visits and used empiric discourse analysis to analyse transitions between activities.
We identified five communication activities that occurred in the following typical sequence: 'diagnosis delivery', 'risk classification', 'options talk', 'decision talk' and 'next steps'. The first two activities were typically brief and involved minimal patient participation. Options talk was typically the longest activity; physicians explicitly announced the beginning of options talk and framed it as their professional responsibility. Some patients were unsure of the purpose of visit and/or who should make treatment decisions.
Visits to deliver the diagnosis of early stage prostate cancer follow a regular sequence of communication activities. Physicians focus on discussing treatment options and devote comparatively little time and attention to discussing the new cancer diagnosis. Towards the goal of promoting patient-centred communication, physicians should consider eliciting patient reactions after diagnosis delivery and explaining the decision-making process before describing treatment options.
我们对在讨论前列腺癌诊断和治疗的就诊过程中患者与医生之间的沟通了解甚少。
研究在患者初次被诊断为前列腺癌的就诊过程中的整体就诊结构，以及患者和医生在沟通活动之间是如何过渡的。
一家退伍军人医疗中心的40名退伍军人和18名泌尿科医生。
我们对40份就诊记录进行编码，以确定就诊期间的主要沟通活动，并使用实证话语分析来分析活动之间的过渡。
我们确定了五个按以下典型顺序发生的沟通活动：“诊断告知”“风险分类”“方案讨论”“决策讨论”和“后续步骤”。前两个活动通常很简短，患者参与度很低。方案讨论通常是最长的活动；医生明确宣布方案讨论开始，并将其视为自己的专业职责。一些患者不确定就诊目的和/或应由谁做出治疗决定。
初次诊断早期前列腺癌的就诊遵循常规的沟通活动顺序。医生专注于讨论治疗方案，而在讨论新的癌症诊断方面投入的时间和精力相对较少。为了实现促进以患者为中心的沟通这一目标，医生应考虑在诊断告知后引发患者的反应，并在描述治疗方案之前解释决策过程。
