Mazer Benjamin L, Cameron Rachel A, DeLuca Jane M, Mohile Supriya G, Epstein Ronald M
Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA.
Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA.
Patient Educ Couns. 2014 Jul;96(1):36-42. doi: 10.1016/j.pec.2014.05.001. Epub 2014 May 9.
To examine using audio-recorded encounters the extent and process of companion participation when discussing treatment choices and prognosis in the context of a life-limiting cancer diagnosis.
Qualitative analysis of transcribed outpatient visits between 17 oncologists, 49 patients with advanced cancer, and 34 companions.
46 qualifying companion statements were collected from a total of 28 conversations about treatment choices or prognosis. We identified a range of companion positions, from "pseudo-surrogacy" (companion speaking as if the patient were not able to speak for himself), "hearsay", "conflation of thoughts", "co-experiencing", "observation as an outsider", and "facilitation". Statements made by companions were infrequently directly validated by the patient.
Companions often spoke on behalf of patients during discussions of prognosis and treatment choices, even when the patient was present and capable of speaking on his or her own behalf.
The conversational role of companions as well as whether the physician checks with the patient can determine whether a companion facilitates or inhibits patient autonomy and involvement. Physicians can reduce ambiguity and encourage patient participation by being aware of when and how companions may speak on behalf of patients and by corroborating the companion's statement with the patient.
通过音频记录的医患交流，研究在晚期癌症诊断背景下讨论治疗选择和预后时陪伴者参与的程度和过程。
对17名肿瘤学家、49名晚期癌症患者和34名陪伴者之间的门诊就诊记录进行定性分析。
在总共28次关于治疗选择或预后的对话中，收集到46条符合条件的陪伴者陈述。我们确定了一系列陪伴者的立场，从“假代理”（陪伴者说话就好像患者无法为自己说话一样）、“道听途说”、“思想混淆”、“共同体验”、“作为局外人的观察”到“促进”。陪伴者的陈述很少得到患者的直接认可。
即使患者在场且能够代表自己发言，陪伴者在讨论预后和治疗选择时仍经常代表患者发言。
陪伴者的对话角色以及医生是否与患者核实情况，会决定陪伴者是促进还是抑制患者的自主性和参与度。医生可以通过了解陪伴者何时以及如何代表患者发言，并与患者核实陪伴者的陈述，来减少模糊性并鼓励患者参与。
