Pinheiro Ana P M, Pocock Rachel H, Dixon Margie D, Shaib Walid L, Ramalingam Suresh S, Pentz Rebecca D
Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
Emory University School of Medicine, Atlanta, Georgia, USA.
Oncologist. 2017 Apr;22(4):445-449. doi: 10.1634/theoncologist.2016-0270. Epub 2017 Feb 20.
Molecular testing to identify targetable molecular alterations is routine practice for several types of cancer. Explaining the underlying molecular concepts can be difficult, and metaphors historically have been used in medicine to provide a common language between physicians and patients. Although previous studies have highlighted the use and effectiveness of metaphors to help explain germline genetic concepts to the general public, this study is the first to describe the use of metaphors to explain molecular testing to cancer patients in the clinical setting.
Oncologist-patient conversations about molecular testing were recorded, transcribed verbatim, and coded. If a metaphor was used, patients were asked to explain it and assess its helpfulness.
Sixty-six patients participated. Nine oncologists used metaphors to describe molecular testing; 25 of 66 (38%) participants heard a metaphor, 13 of 25 (52%) were questioned, 11 of 13 (85%) demonstrated understanding and reported the metaphor as being useful. Seventeen metaphors (bus driver, boss, switch, battery, circuit, broken light switch, gas pedal, key turning off an engine, key opening a lock, food for growth, satellite and antenna, interstate, alternate circuit, traffic jam, blueprint, room names, Florida citrus) were used to explain eight molecular testing terms (driver mutations, targeted therapy, hormones, receptors, resistance, exon specificity, genes, and cancer signatures).
Because metaphors have proven to be a useful communication tool in other settings, these 17 metaphors may be useful for oncologists to adapt to their own setting to explain molecular testing terms. 2017;22:445-449 This article provides a snapshot of 17 metaphors that proved useful in describing 8 complicated molecular testing terms at 3 sites. As complex tumor sequencing becomes standard of care in clinics and widely used in clinical research, the use of metaphors may prove a useful communication tool, as it has in other settings. Although this study had a small sample, almost all of the patients who were exposed to metaphors in explaining molecular testing reported it as being helpful to their understanding. These 17 metaphors are examples of potentially useful communication tools that oncologists can adapt to their own practice.
进行分子检测以识别可靶向的分子改变是多种癌症的常规诊疗手段。解释潜在的分子概念可能会有困难，而隐喻在医学领域一直被用于在医生和患者之间提供一种通用语言。尽管先前的研究强调了隐喻在向公众解释种系遗传概念方面的应用及有效性，但本研究是首个描述在临床环境中使用隐喻向癌症患者解释分子检测的研究。
记录肿瘤学家与患者关于分子检测的对话，逐字转录并编码。如果使用了隐喻，会要求患者对其进行解释并评估其帮助程度。
66名患者参与。9名肿瘤学家使用隐喻来描述分子检测；66名参与者中有25名（38%）听到了隐喻，25名中有13名（52%）被询问，13名中的11名（85%）表示理解并报告该隐喻有用。17个隐喻（公交车司机、老板、开关、电池、电路、坏了的电灯开关、油门踏板、关闭发动机的钥匙、打开锁的钥匙、生长所需的食物、卫星和天线、州际公路、备用电路、交通堵塞、蓝图、房间名称）被用于解释8个分子检测术语（驱动突变、靶向治疗、激素、受体、耐药性、外显子特异性、基因和癌症特征）。
由于隐喻在其他环境中已被证明是一种有用的沟通工具，这17个隐喻可能有助于肿瘤学家根据自身情况来解释分子检测术语。2017年；22:445 - 449 本文提供了17个隐喻的概况，这些隐喻在3个地点被证明对描述8个复杂的分子检测术语有用。随着复杂肿瘤测序在临床成为标准治疗手段并广泛应用于临床研究，隐喻的使用可能会像在其他环境中一样，被证明是一种有用的沟通工具。尽管本研究样本量较小，但几乎所有在解释分子检测时接触到隐喻的患者都报告说这有助于他们理解。这17个隐喻是肿瘤学家可根据自身实践进行调整的潜在有用沟通工具的示例。
