Ewing Gail, Ngwenya Nothando, Benson John, Gilligan David, Bailey Susan, Seymour Jane, Farquhar Morag
Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK.
Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK.
Patient Educ Couns. 2016 Mar;99(3):378-385. doi: 10.1016/j.pec.2015.09.013. Epub 2015 Oct 9.
Extensive research exists on breaking bad news by clinicians. This study examines perspectives of patients and those accompanying them at diagnosis-giving of subsequently sharing news of lung cancer with adult family/friends, and views of healthcare professionals, to inform development of a supportive intervention.
Qualitative interviews with 20 patients, 17 accompanying persons; focus groups and interviews with 27 healthcare professionals from four Thoracic Oncology Units. Intervention development workshops with 24 healthcare professionals and six service users with experience of sharing a cancer diagnosis. Framework thematic analysis.
Patients and accompanying persons shared news of lung cancer whilst coming to terms with the diagnosis. They recalled general support from healthcare professionals but not support with sharing bad news. Six elements were identified providing a framework for a potential intervention: 1-people to be told, 2-information to be shared, 3-timing of sharing, 4-responsibility for sharing, 5-methods of telling others and 6-reactions of those told.
This study identifies the challenge of sharing bad news and a potential framework to guide delivery of a supportive intervention tailored to individual needs of patients.
The identified framework could extend the portfolio of guidance on communication in cancer and potentially in other life-limiting conditions.
临床医生在传达坏消息方面已有大量研究。本研究调查了患者及其陪同人员在得知肺癌诊断后与成年家人/朋友分享消息的观点，以及医疗保健专业人员的看法，以为支持性干预措施的制定提供参考。
对20名患者、17名陪同人员进行定性访谈；对来自四个胸科肿瘤科室的27名医疗保健专业人员进行焦点小组讨论和访谈。与24名医疗保健专业人员和6名有分享癌症诊断经历的服务使用者举办干预措施制定研讨会。采用框架主题分析法。
患者及其陪同人员在接受肺癌诊断的过程中分享了消息。他们回忆起医疗保健专业人员给予的一般支持，但在分享坏消息方面没有得到支持。确定了六个要素，为潜在干预措施提供了框架：1.要告知的人；2.要分享的信息；3.分享的时机；4.分享的责任；5.告知他人的方法；6.被告知者的反应。
本研究确定了分享坏消息的挑战以及一个潜在框架，以指导为满足患者个体需求而提供的支持性干预措施。
所确定的框架可以扩展癌症及其他可能危及生命疾病的沟通指导内容。
