Furber L, Murtagh G M, Bonas S A, Bankart J G, Thomas A L
Department of Cancer Studies and Molecular Medicine, Osborne Building, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK.
Br J Cancer. 2014 Mar 4;110(5):1101-9. doi: 10.1038/bjc.2013.749. Epub 2014 Feb 18.
The way in which patients receive bad news in a consultation can have a profound effect in terms of anxiety, depression and subsequent adjustment. Despite investment in well-researched communication skills training and availability of decision-making aids, communication problems in oncology continue to be encountered.
We conducted a mixed-methods study in a large UK Cancer Centre to develop a novel consultation aid that could be used jointly by patients and doctors. Consultations were audio-recorded and both the doctors and the patients were interviewed. We used conversation analysis to analyse the consultation encounter and interpretative phenomenological analysis to analyse the interviews. Key themes were generated to inform the design of the aid.
A total of 16 doctors were recruited into the study along with 77 patients. Detailed analysis from 36 consultations identified key themes (including preparation, information exchange, question-asking and decision making), which were subsequently addressed in the design of the paper-based aid.
Using detailed analysis and observation of oncology consultations, we have designed a novel consultation aid that can be used jointly by doctors and patients. It is not tumour-site specific and can potentially be utilised by new and follow-up consultations.
患者在会诊中接收坏消息的方式在焦虑、抑郁及后续调整方面可能产生深远影响。尽管在经过充分研究的沟通技能培训方面投入不少且有决策辅助工具可用，但肿瘤学领域的沟通问题仍时有发生。
我们在英国一家大型癌症中心开展了一项混合方法研究，以开发一种可供患者和医生共同使用的新型会诊辅助工具。会诊进行了录音，并对医生和患者都进行了访谈。我们采用会话分析来分析会诊过程，并用解释现象学分析来分析访谈内容。生成关键主题以指导辅助工具的设计。
共有16名医生和77名患者参与了该研究。对36次会诊的详细分析确定了关键主题（包括准备、信息交流、提问和决策），随后在纸质辅助工具的设计中予以体现。
通过对肿瘤学会诊进行详细分析和观察，我们设计了一种可供医生和患者共同使用的新型会诊辅助工具。它不针对特定肿瘤部位，新会诊和随访会诊都有可能使用。
