Clarkson Rose, Selby Debbie, Myers Jeff
Palliative Care Consult Team, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
BMJ Support Palliat Care. 2013 Sep;3(3):330-4. doi: 10.1136/bmjspcare-2012-000320. Epub 2012 Dec 1.
For patients with advanced and/or incurable disease, clinicians are often called upon to formulate and communicate an estimate of likely survival duration. The objective of this study was to gain a deeper appreciation of this process by identifying and exploring the specific elements that may inform and/or impact a clinician's estimate of survival (CES).
Semistructured interviews were conducted among a group of palliative care clinicians in the setting of a tertiary academic health sciences centre. Qualitative data were subsequently analysed using a grounded theory approach.
Five major themes were identified as being central to the process of CES formulation: use of objective patient-specific elements, strength of the patient-clinician relationship, purpose and context of an individual CES, perceived role of hope and the overall likelihood of CES inaccuracy.
For any given patient, several elements have the potential to inform and/or impact the process of CES formulation. Study participants were aware of objective clinical factors known to correlate with actual survival duration and likely integrate this information when formulating a CES. Formulation occurs within a larger context comprised of a number of elements that may influence individual estimates. These elements exist against a background of awareness of the overall likelihood of CES inaccuracy. Clinicians are encouraged to develop a personalised and standardised approach to CES formulation whereby an awareness of the menu of potentially impacting elements is consciously integrated into an individual process.
对于患有晚期和/或无法治愈疾病的患者，临床医生经常需要制定并传达对可能存活时间的估计。本研究的目的是通过识别和探索可能影响临床医生生存估计（CES）的具体因素，更深入地了解这一过程。
在一家三级学术健康科学中心，对一组姑息治疗临床医生进行了半结构化访谈。随后采用扎根理论方法对定性数据进行分析。
确定了五个主要主题，它们是CES制定过程的核心：使用客观的患者特定因素、患者与临床医生关系的强度、个体CES的目的和背景、希望的感知作用以及CES不准确的总体可能性。
对于任何给定患者，有几个因素可能影响CES制定过程。研究参与者了解已知与实际存活时间相关的客观临床因素，并在制定CES时可能会整合这些信息。制定过程发生在一个由许多可能影响个体估计的因素组成的更大背景中。这些因素存在于对CES不准确总体可能性的认识背景之下。鼓励临床医生制定个性化和标准化的CES制定方法，将对潜在影响因素的认识有意识地融入个体过程中。
