Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Capio St Görans Sjukhus, Stockholm, Sweden.
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Research and Development, Stockholms Sjukhem Foundation, Stockholm, Sweden.
J Pain Symptom Manage. 2019 Apr;57(4):746-752. doi: 10.1016/j.jpainsymman.2018.12.336. Epub 2019 Jan 11.
Women with metastatic breast cancer often receive many lines of palliative chemotherapy, which might be beneficial but also harmful. Still, little is known about the patients' perception of the patient-doctor communication regarding late lines of noncurative treatment.
Our aim was to explore breast cancer patients' preferences and perceptions of patient-doctor communication regarding continuous late lines of palliative chemotherapy.
A qualitative study was conducted with semiguided face-to-face interviews with 20 women, 40-80 years old, on at least their second line of palliative chemotherapy (second to eighth line). We used a qualitative conventional content analysis.
All women knew they had incurable breast cancer but expressed hope for cure. Patients' definition of a good compassionate doctor was one who gives positive news and leaves room for hope. Ongoing chemotherapy, positive news from the doctors, and support from relatives encouraged hope. The women often expressed they accepted chemotherapy to please their doctor and relatives. The informants appreciated the doctor to be honest, but within positive limits. Over time, they stopped asking questions afraid of getting bad news, and left more and more treatment decisions to the doctor.
The women's preferences for truth versus hope in patient-doctor communication changed over time, which increase the risk for continuous late lines of palliative chemotherapy by common collusion. Doctors need to individualize information, help patients make sense of their life, and allow hope to endure without further chemotherapy.
转移性乳腺癌女性常接受多线姑息化疗，这些化疗可能有益也可能有害。然而，人们对患者对非治愈性晚期治疗的医患沟通的看法知之甚少。
我们旨在探讨乳腺癌患者对晚期姑息性化疗连续治疗的医患沟通的偏好和看法。
对 20 名年龄在 40-80 岁之间的女性进行了半结构化面对面访谈，这些女性至少接受了二线姑息化疗（二线至八线）。我们使用了定性常规内容分析。
所有女性都知道自己患有不可治愈的乳腺癌，但仍抱有治愈的希望。患者对富有同情心的好医生的定义是能够给予积极的消息并留有希望的空间的医生。持续的化疗、医生的积极消息和亲属的支持鼓励了希望。女性经常表示，她们接受化疗是为了取悦医生和亲属。患者希望医生诚实，但要保持在积极的范围内。随着时间的推移，她们停止提问，害怕听到坏消息，并将越来越多的治疗决策留给医生。
女性在医患沟通中对真相与希望的偏好随时间而变化，这增加了因共同共谋而持续进行晚期姑息性化疗的风险。医生需要个体化信息，帮助患者理解自己的生活，并在不进行进一步化疗的情况下允许希望持续。
