a McGill University Faculty of Medicine, Ingram School of Nursing , Montreal , Quebec , Canada.
b St. Mary's Research Centre , Montreal , Quebec , Canada.
J Psychosoc Oncol. 2018 Jan-Feb;36(1):82-96. doi: 10.1080/07347332.2017.1382645. Epub 2017 Nov 21.
To examine (1) approaches used by oncologists to administer the palliative care needs assessment tool (PC-NAT) in consultations with patients with advanced cancer and their caregivers, (2) potential of this tool to facilitate discussion of psychosocial issues, and (3) whether use of the tool alters the length of consultations.
A qualitative analysis was undertaken of audio-taped, outpatient consultations.
20 individuals with advanced cancer and their caregivers who participated in an interrupted time series study of the impact of the systematic utilization of the PC-NAT had a total of 48 consultations audio-taped. These included 13 baseline recordings where PC-NAT was not completed and 35 that included completion of the PC-NAT. Audio-tapes were coded and SPSS was used to calculate the impact of using the PC-NAT on consultation length.
This study revealed that the administration of the PC-NAT was not optimal to identify and discuss psychosocial concerns. The PC-NAT was delivered without an explanation of the function of the assessment and in jargonistic terms, and tended not to be integrated into the consultation. The majority of the interactions' content related to physical health issues. The range of empathic responses given by the oncologist in regards to patient and caregiver concerns ranged from low (denial/disconfirmation) to very high (confirmation), though codes "dismissing" or "denying" were mainly assigned to psychosocial concerns compared to medical ones. There was no significant increase in consultation time when the routine needs assessment was included. Conclusion and interpretation: Staff training to enhance understanding and facilitate the timely use of the PC-NAT is warranted as well as to enhance response to unmet needs as part of routine care needs assessment tool.
（1）考察肿瘤学家在与晚期癌症患者及其照顾者的咨询中使用姑息治疗需求评估工具（PC-NAT）的方法；（2）该工具促进讨论心理社会问题的潜力；（3）使用该工具是否会改变咨询时间。
对门诊咨询的音频进行定性分析。
20 名患有晚期癌症的患者及其照顾者参加了一项关于系统使用 PC-NAT 对其影响的中断时间序列研究，他们总共进行了 48 次咨询的音频记录。其中包括 13 次未完成 PC-NAT 的基线记录和 35 次完成 PC-NAT 的记录。对音频进行编码，使用 SPSS 计算使用 PC-NAT 对咨询时间长度的影响。
本研究表明，PC-NAT 的管理不能很好地识别和讨论心理社会问题。PC-NAT 的提供没有解释评估的功能和使用术语，并且往往没有融入咨询中。大多数互动的内容与身体健康问题有关。在患者和照顾者的问题上，肿瘤学家的共情反应范围从低（否认/不确认）到非常高（确认），尽管与医疗问题相比，主要给与心理社会问题分配了“忽视”或“否认”的代码。当包括常规需求评估时，咨询时间没有明显增加。结论和解释：需要对员工进行培训，以提高对 PC-NAT 的理解和促进其及时使用，并增强对常规需求评估工具中未满足需求的反应。
