Practical Justice Initiative, Centre for Social Research in Health, Level 3 John Goodsell Building, UNSW Sydney, Kensington, 2052, Australia.
Warwick MedicalSchool, University of Warwick, Coventry, UK.
Support Care Cancer. 2020 Jan;28(1):229-238. doi: 10.1007/s00520-019-04796-z. Epub 2019 Apr 24.
A cancer diagnosis is an emotive and challenging time for patients. This study aimed to systematically explore patients' accounts of experiencing their cancer diagnosis. The purpose of this article is to offer a typology of patient responses to receiving a cancer diagnosis as a means through which to affirm the range of patients' experiences and to guide clinicians' practice.
Qualitative semi-structured interviews were conducted between 2015 and 2017 with 80 patients living with cancer: 34 females and 46 males, aged between 31 and 85, diagnosed with a range of cancer types, stages and treatment trajectories, from two metropolitan hospitals on the east coast of Australia. Interview data were analysed thematically, using the framework approach.
A typology of responses to the cancer diagnosis was derived from the analysis and included (1) the incongruent diagnosis, unexpected because it did not 'fit' with the patient's 'healthy' identity; (2) the incidental diagnosis, arising from seemingly unrelated or minor medical investigations; (3) the validating diagnosis, as explanation and confirmation of previously unexplained symptoms, pain or feelings; (4) the life context diagnosis, where the cancer diagnosis was positioned relative to other challenging life events, or as relatively inconsequential compared with the hardship of others.
A diagnosis of cancer is not always (or only) experienced by patients with shock and despair. Diagnosis is perceived and experienced in diverse ways, shaped by broader social or life contexts, and with important implications for the clinical encounter and communication from an oncology perspective.
癌症诊断对患者来说是一个情绪化和具有挑战性的时刻。本研究旨在系统地探讨患者对癌症诊断的体验。本文的目的是提供一种患者对癌症诊断反应的类型学，作为肯定患者体验范围的一种方式，并指导临床医生的实践。
2015 年至 2017 年间，在澳大利亚东海岸的两家大都市医院，对 80 名患有癌症的患者（34 名女性和 46 名男性）进行了定性半结构式访谈，年龄在 31 岁至 85 岁之间，诊断出多种癌症类型、分期和治疗轨迹。使用框架方法对访谈数据进行了主题分析。
从分析中得出了对癌症诊断的反应类型学，包括（1）不一致的诊断，因为它与患者的“健康”身份不“相符”，所以出乎意料；（2）偶然的诊断，源于看似无关或轻微的医疗调查；（3）验证性诊断，作为对先前无法解释的症状、疼痛或感觉的解释和确认；（4）生活背景诊断，其中癌症诊断相对于其他具有挑战性的生活事件进行定位，或者与他人的困难相比相对不重要。
癌症诊断并不总是（或仅）被患者感到震惊和绝望。诊断以不同的方式被感知和体验，受更广泛的社会或生活背景的影响，并对肿瘤学角度的临床相遇和沟通产生重要影响。
