Department of Sociology, University of Wisconsin-Madison, Madison, United States.
Department of Sociology, University of Wisconsin-Madison, Madison, United States.
Patient Educ Couns. 2019 Feb;102(2):216-222. doi: 10.1016/j.pec.2018.07.002. Epub 2018 Jul 6.
Analyze entire oncology clinical visits and examine instances in which oncologists have to break the bad news that patients' treatments are no longer effective.
Using conversation analysis we examine 128 audio recorded conversations between terminal cancer patients, their caregivers, and oncologists.
When oncologists break the bad news that a patient's treatment is no longer effective, they often use a conversational device we call an "exhausted current treatment" (ECT) statement, which avoids discussing prognosis in favor of further discussing treatment options. Analysis suggests that improving and prioritizing patient-centered care and shared decision making is possible if we first understand the social organization of clinical visits.
ECT statements and their movement towards discussing treatment options means that opportunities are bypassed for patients and caregivers to process or discuss scan results, and their prognostic implications.
When oncologists and patients, by fixating on treatment options, bypass opportunities to discuss the meaning of scan results, they fail to realize other goals associated with prognostic awareness. Talking about what scans mean may add minutes to that part of the clinic visit, but can create efficiencies that conserve overall time. We recommend that oncologists, after delivering scan news, ask, "Would you like discuss what this means?".
分析整个肿瘤学临床就诊过程，并研究肿瘤学家不得不告知患者治疗不再有效的情况。
我们使用会话分析方法，研究了 128 个由晚期癌症患者、他们的护理人员和肿瘤学家之间的音频记录对话。
当肿瘤学家告知患者治疗不再有效的坏消息时，他们经常使用我们称之为“用尽当前治疗”（ECT）陈述的会话手段，避免讨论预后，转而进一步讨论治疗方案。分析表明，如果我们首先了解临床就诊的社会组织，就有可能改善和优先考虑以患者为中心的护理和共同决策。
ECT 陈述及其向讨论治疗方案的转变意味着患者和护理人员错过了处理或讨论扫描结果及其预后影响的机会。
当肿瘤学家和患者通过关注治疗方案而绕过讨论扫描结果意义的机会时，他们未能实现与预后意识相关的其他目标。谈论扫描结果意味着什么可能会增加该就诊部分的几分钟，但可以创造效率，从而节省整体时间。我们建议肿瘤学家在传递扫描结果后询问，“您想讨论一下这意味着什么吗？”。
