Alby Francesca, Fatigante Marilena, Zucchermaglio Cristina
Department of Developmental and Social Psychology, Sapienza University of Rome, Italy.
Sociol Health Illn. 2017 Nov;39(8):1427-1447. doi: 10.1111/1467-9566.12598. Epub 2017 Aug 21.
Drawing on conversation analyses of oncology consultations collected in Italy, the article examines the communication practices used to recommend treatments. We found that the oncologist formulates the treatment recommendation (TR) for high-risk patients in terms of a 'mandatory' choice and for low-risk patients as an 'optional' type of decision. In the first case the doctor presses to reach a decision during the visit while in the second case leaves the decision open-ended. Results show that high-risk patients have less time to decide, are pressured towards choosing an option, but have more opportunities for involvement in TR during the visit. Low-risk patients instead have more time and autonomy to make a choice, but they are also less involved in the decision-making in the visit time. Moreover, we document that TR is organised through sequential activities in which the oncologist informs the patient of alternative therapeutic options while at the same time building a case for the kind of treatment she/he believes to be best for the patient's health. We suggest that in this field risk plays a key role in decision-making which should be better understood with further studies and taken into account in the debate on shared decision-making and patient-centred communication.
基于在意大利收集的肿瘤学咨询对话分析，本文考察了用于推荐治疗方案的沟通方式。我们发现，肿瘤医生针对高危患者，将治疗建议（TR）表述为一种“强制性”选择，而针对低危患者，则作为一种“可选择”的决策类型。在前一种情况下，医生在就诊期间催促患者做出决定，而在后一种情况下，则让决定保持开放性。结果显示，高危患者做决定的时间较少，被迫选择一个选项，但在就诊期间参与治疗建议讨论的机会更多。相反，低危患者有更多时间和自主权做出选择，但他们在就诊时参与决策的程度也较低。此外，我们记录到，治疗建议是通过一系列活动来组织的，在这些活动中，肿瘤医生告知患者其他治疗选择，同时为她/他认为对患者健康最有利的那种治疗方案提供依据。我们认为，在这个领域，风险在决策中起着关键作用，这一点应通过进一步研究得到更好的理解，并在关于共同决策和以患者为中心的沟通的辩论中加以考虑。
