Maynard Douglas W
Department of Sociology University of Wisconsin Madison Wisconsin.
Acute Med Surg. 2016 May 16;4(1):3-11. doi: 10.1002/ams2.210. eCollection 2017 Jan.
Forecasting is a strategy for delivering bad news and is compared to two other strategies, stalling and being blunt. Forecasting provides some warning that bad news is forthcoming without keeping the recipient in a state of indefinite suspense (stalling) or conveying the news abruptly (being blunt). Forecasting appears to be more effective than stalling or being blunt in helping a recipient to "realize" the bad news because it involves the deliverer and recipient in a particular social relation. The deliverer of bad news initiates the telling by giving an advance indication of the bad news to come; this allows the recipient to calculate the news in advance of its final presentation, when the deliverer confirms what the recipient has been led to anticipate. Thus, realization of bad news emerges from intimate collaboration, whereas stalling and being blunt require recipients to apprehend the news in a social vacuum. Exacerbating disruption to recipients' everyday world, stalling and being blunt increase the probability of misapprehension (denying, blaming, taking the situation as a joke, etc.) and thereby inhibit rather than facilitate realization. Particular attention is paid to the "perspective display sequence", a particular forecasting strategy that enables both confirming the recipient's perspective and using that perspective to affirm the clinical news. An example from acute or emergency medicine is examined at the close of the paper.
预告是一种传达坏消息的策略，它与另外两种策略——拖延和直言不讳——进行了比较。预告会给出一些即将有坏消息的警示，既不会让接收者处于无限期的悬念状态（拖延），也不会突然传达消息（直言不讳）。预告在帮助接收者“意识到”坏消息方面似乎比拖延或直言不讳更有效，因为它使传达者和接收者处于一种特定的社会关系中。坏消息的传达者通过提前暗示即将到来的坏消息来开启讲述；这让接收者在最终听到消息之前就能预先推测，当传达者确认接收者一直预期的事情时便是如此。因此，坏消息的意识到来自亲密合作，而拖延和直言不讳则要求接收者在社会真空中理解消息。拖延和直言不讳加剧了对接收者日常世界的干扰，增加了误解（否认、指责、把情况当作玩笑等）的可能性，从而抑制而非促进意识到。文中特别关注了“视角展示序列”，这是一种特定的预告策略，它既能确认接收者的视角，又能利用该视角来肯定临床消息。本文结尾处研究了一个来自急性或急诊医学的例子。
