Hoff Lena, Hermerén Göran
Lund University, Department of Medical Ethics, BMC C:13, SE-221, Lund, sweden.
J Clin Ethics. 2014 Winter;25(4):296-306.
The research literature suggests that physicians' attitudes regarding disclosing a diagnosis of cancer have changed, from nondisclosure to full disclosure. Physicians' attitudes towards disclosing a patient's prognosis are likewise said to have changed, although not to the same degree. The aim of this study was to identify inherent challenges in communicating information about imminent death. It included one set of interviews with patients and another set with doctors, and subsequent discussions of ways to overcome obstacles to patients' understanding their situation. Patients were diagnosed with leukemia, myeloma, or lung cancer; the doctors were hematologists and lung oncologists. The two sets of interviews were analyzed separately using a content analysis model developed by Graneheim and Lundman. For each set of interviews, eight content areas were defined as belonging to an area of interest and scrutinized for the information they included regarding communicating prognoses to patients. The main finding was a discrepancy between patients' desire to be fully informed regarding their prognosis and physicians' reluctance to offer a prognosis until a patient had overt signs of approaching death. We conclude that existing guidelines for disclosure of bad news should be modified to encourage disclosure and discussion of uncertain prognostic information, unless a patient is clearly opposed to receiving such information or otherwise not a suitable partner for dialogue.
研究文献表明，医生对于透露癌症诊断的态度已经发生了变化，从隐瞒转变为完全披露。据说医生对于透露患者预后的态度同样也发生了变化，尽管程度不尽相同。本研究的目的是确定在传达即将死亡的信息时所面临的内在挑战。该研究包括一组对患者的访谈和另一组对医生的访谈，以及随后关于如何克服阻碍患者了解自身状况的障碍的讨论。患者被诊断患有白血病、骨髓瘤或肺癌；医生为血液科医生和肺部肿瘤学家。使用Graneheim和Lundman开发的内容分析模型分别对两组访谈进行了分析。对于每组访谈，八个内容领域被定义为属于一个感兴趣的领域，并对其中包含的关于向患者传达预后的信息进行了审查。主要发现是，患者希望充分了解其预后的愿望与医生在患者出现临近死亡的明显迹象之前不愿提供预后之间存在差异。我们得出结论，现有的坏消息披露指南应加以修改，以鼓励披露和讨论不确定的预后信息，除非患者明确反对接收此类信息或以其他方式不适合作为对话对象。
