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“没有我想象的那么糟糕”:对早期非小细胞肺癌患者治疗后的定性研究

"It wasn't as bad as I thought it would be": a qualitative study of early stage non-small cell lung cancer patients after treatment.

作者信息

Golden Sara E, Thomas Charles R, Deffebach Mark E, Sukumar Mithran S, Schipper Paul H, Tieu Brandon H, Kee Andrew Y, Tsen Andrew C, Slatore Christopher G

机构信息

Health Services Research & Development, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd., R&D 66, Portland, OR, 97239, USA.

Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA.

出版信息

BMC Res Notes. 2017 Nov 29;10(1):642. doi: 10.1186/s13104-017-2956-3.

Abstract

OBJECTIVE

While surgical resection is recommended for most patients with early stage lung cancer, stereotactic body radiotherapy (SBRT) is being increasingly utilized. Provider-patient communication regarding risks/benefits of each approach may be a modifiable factor leading to improved patient-centered outcomes. Our objective was to determine a framework and recommended strategies on how to best communicate with patients with early stage non-small cell lung cancer (NSCLC) in the post-treatment setting. We qualitatively evaluated the experiences of 11 patients with early clinical stage NSCLC after treatment, with a focus on treatment experience, knowledge obtained, communication, and recommendations. We used conventional content analysis and a patient-centered communication theoretical model to guide our understanding.

RESULTS

Five patients received surgery and six received SBRT. Both treatments were generally well-tolerated. Few participants reported communication deficits around receiving follow-up information, although several had remaining questions about their treatment outcome (mainly those who underwent SBRT). They described feeling anxious regarding their first surveillance CT scan and clinician visit. Overall, participants remained satisfied with care because of implicit trust in their clinicians rather than explicit communication. Communication gaps remain but may be addressed by a trusting relationship with the clinician. Patients recommend clinicians give thorough explanations and personalize when possible.

摘要

目的

虽然对于大多数早期肺癌患者推荐手术切除,但立体定向体部放疗(SBRT)的应用越来越广泛。关于每种治疗方法的风险/益处的医患沟通可能是一个可改变的因素,有助于改善以患者为中心的治疗结果。我们的目的是确定一个框架以及推荐的策略,以指导如何在治疗后环境中与早期非小细胞肺癌(NSCLC)患者进行最佳沟通。我们对11例临床早期NSCLC患者治疗后的经历进行了定性评估,重点关注治疗体验、获得的知识、沟通情况及建议。我们采用传统内容分析法和以患者为中心的沟通理论模型来指导我们的理解。

结果

5例患者接受了手术,6例接受了SBRT。两种治疗的耐受性总体良好。很少有参与者报告在接收随访信息方面存在沟通缺陷,尽管有几位患者对其治疗结果仍有疑问(主要是接受SBRT的患者)。他们描述了在首次监测CT扫描和看诊医生时感到焦虑。总体而言,参与者对治疗仍感满意,这是因为对临床医生的隐性信任而非明确的沟通。沟通差距仍然存在,但可通过与临床医生建立信任关系来解决。患者建议临床医生进行全面解释,并尽可能做到个性化。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/376d/5708159/8f8f8e027497/13104_2017_2956_Fig1_HTML.jpg

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