Broom Alex, Kirby Emma, Good Phillip, Wootton Julia, Adams Jon
1The University of Queensland, Brisbane, Queensland, Australia.
Qual Health Res. 2014 Feb;24(2):151-62. doi: 10.1177/1049732313519709. Epub 2014 Jan 27.
Communication about palliative care represents one of the most difficult interpersonal aspects of medicine. Delivering the "terminal" diagnosis has traditionally been the focus of research, yet transitions to specialist palliative care are equally critical clinical moments. Here we focus on 20 medical specialists' strategies for engaging patients around referral to specialist palliative care. Our aim was to develop an understanding of the logics that underpin their communication strategies when negotiating this transition. We draw on qualitative interviews to explore their accounts of deciding whether and when to engage in referral discussions; the role of uncertainty and the need for hope in shaping communication; and their perceptions of how patient biographies might shape their approaches to, and communication about, the end of life. On the basis of our analysis, we argue that communication is embedded in social relations of hope, justice, and uncertainty, as well as being shaped by patient biographies.
关于姑息治疗的沟通是医学中人际交流最困难的方面之一。传统上，传达“终末期”诊断一直是研究的重点，但向专科姑息治疗的过渡同样是关键的临床时刻。在此，我们聚焦于20位医学专家在引导患者转诊至专科姑息治疗方面的策略。我们的目的是深入理解他们在协商这一过渡时沟通策略背后的逻辑。我们通过定性访谈来探究他们对于决定是否以及何时展开转诊讨论的叙述；不确定性和希望的需求在塑造沟通方面所起的作用；以及他们对于患者生平如何可能影响其对待生命末期的方式及相关沟通的看法。基于我们的分析，我们认为沟通既根植于希望、正义和不确定性的社会关系之中，同时也受到患者生平的影响。
