Henselmans Inge, Van Laarhoven Hanneke Wm, Van der Vloodt Jane, De Haes Hanneke Cjm, Smets Ellen Ma
1 Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands.
2 Department of Medical Oncology, Academic Medical Center, University of Amsterdam, The Netherlands.
Palliat Med. 2017 Jul;31(7):625-633. doi: 10.1177/0269216316676010. Epub 2016 Oct 26.
Particularly at the end of life, treatment decisions should be shared and incorporate patients' preferences. This study examines elaboration and preference construction.
To examine the values, appraisals and preferences that patients express, as well as the oncologists' communicative behaviour that facilitates these expressions in consultations on palliative chemotherapy.
Verbatim transcripts of audio-recorded consultations ( n = 60) were analysed in MAXqda10 software. Two independent coders identified and categorised patients' preference-related utterances and oncologists' utterances, preceding and following such expressions.
SETTING/PARTICIPANTS: Cancer patients ( n = 41) with a median life expectancy <1 year and oncologists ( n = 13) meeting with them in either initial or evaluative follow-up consultations.
Most frequent were patients' expressions of treatment preferences (65% of consultations), often the simple wish to have treatment. Expressions of underlying values (48%) and appraisals of treatment aspects (50%) were less common. Most preference-related utterances concerned single statements (59%); in 51% of the consultations, true dialogue was observed. Preference-related utterances were least common in follow-up consultations concerning stable disease or response. Preference-related fragments were patient-initiated (42%), oncologist-facilitated (28%) or oncologist-invited (30%). Oncologist responses likely to trigger more preference-related talk were showing empathy, checking and probe questioning. Likely to reduce space were providing information, personally agreeing and neutral responses.
Elaboration and joint preference construction is not standard practice in consultations on palliative chemotherapy. Oncologists may benefit from realising this and training skills that support this key step of shared decision making. Also, repeated shared decision making throughout the course of palliative chemotherapy should be stimulated.
尤其是在生命末期，治疗决策应共同做出并纳入患者的偏好。本研究探讨了详述与偏好构建。
研究患者表达的价值观、评估和偏好，以及肿瘤学家在姑息化疗咨询中促进这些表达的沟通行为。
在MAXqda10软件中分析了录音咨询的逐字记录（n = 60）。两名独立编码员识别并分类了患者与偏好相关的话语以及肿瘤学家在此类表达之前和之后的话语。
背景/参与者：中位预期寿命<1年的癌症患者（n = 41）以及在初次或评估性随访咨询中与他们会面的肿瘤学家（n = 13）。
最常见的是患者对治疗偏好的表达（65%的咨询），通常只是简单希望接受治疗。潜在价值观的表达（48%）和对治疗方面的评估（50%）则不太常见。大多数与偏好相关的话语涉及单一陈述（59%）；在51%的咨询中观察到了真正的对话。与偏好相关的话语在关于疾病稳定或缓解的随访咨询中最不常见。与偏好相关的片段由患者发起（42%）、肿瘤学家促成（28%）或肿瘤学家邀请（30%）。可能引发更多与偏好相关讨论的肿瘤学家回应是表现出同理心、进行核实和探究性提问。可能减少交流空间的回应是提供信息、个人认同和中性回应。
在姑息化疗咨询中，详述和共同构建偏好并非标准做法。肿瘤学家可能会从意识到这一点并培养支持这一共同决策关键步骤的技能中受益。此外，应鼓励在姑息化疗过程中反复进行共同决策。
