Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
Cancer. 2019 Oct 1;125(19):3320-3329. doi: 10.1002/cncr.32327. Epub 2019 Jun 17.
Nondisclosure of a poor prognosis to patients with advanced cancer remains a typical practice in Asia. Although the importance of prognostic communication has increasingly been recognized worldwide, little is known about whether explicit prognostic disclosure positively affects Asian patients with advanced cancer. The objective of this study was to examine the effects of explicit prognostic communication on patients with cancer recurrence.
In this randomized, video-vignette study, Japanese women with breast cancer who had undergone curative surgery viewed videos of prognostic communication between a patient with recurrent, incurable breast cancer and her oncologist. The videos differed only in the presence or absence of explicit prognostic disclosure. The primary outcome was participants' uncertainty (rated from 0 to 10), and the secondary outcomes included anxiety (measured on the State-Trait Anxiety Inventory-State: range, 20-80), satisfaction (Patient Satisfaction Questionnaire; range 0-10), self-efficacy (range, 0-10), and willingness to discuss advance care planning (range, 1-4).
In total, 105 women participated (mean ± SD age, 53.8 ± 8.2 years). After viewing the video with more versus less explicit disclosure, participants showed significantly lower uncertainty (mean ± SE scores, 5.3 ±0.2 vs 5.7 ± 0.2, respectively; P = .032) and higher satisfaction (5.6 ± 0.2 vs 5.2 ± 0.2, respectively; P = .010) without increasing anxiety (changes in scores on the State-Trait Anxiety Inventory-State: 0.06 ± 0.5 vs 0.6 ± 0.5, respectively; P = .198). No significant differences were observed in self-efficacy (5.2 ± 0.2 vs 5.0 ± 0.2, respectively; P = .277) or willingness to discuss advance care planning (2.7 ± 0.1 vs 2.7 ± 0.1, respectively; P = .240).
Explicit prognostic disclosure prompted better outcomes than nondisclosure in Japanese women with breast cancer. When asked about the prognosis by Asian patients with cancer, clinicians may be encouraged to respect their wishes and explicitly discuss the prognosis if deemed appropriate.
在亚洲,不向晚期癌症患者透露预后不良的情况仍然是一种典型做法。尽管全球范围内越来越认识到预后沟通的重要性,但对于明确的预后披露是否会对亚洲晚期癌症患者产生积极影响知之甚少。本研究的目的是检验明确的预后沟通对癌症复发患者的影响。
在这项随机、视频短片研究中,接受过根治性手术的日本乳腺癌女性观看了一位复发、不可治愈的乳腺癌患者与她的肿瘤医生之间的预后沟通视频。这些视频仅在是否明确透露预后方面存在差异。主要结局是参与者的不确定性(评分范围为 0 到 10),次要结局包括焦虑(状态特质焦虑量表状态:范围 20-80)、满意度(患者满意度问卷;范围 0-10)、自我效能(范围 0-10)和讨论预先护理计划的意愿(范围 1-4)。
共有 105 名女性参与(平均年龄±标准差为 53.8±8.2 岁)。与观看较少明确披露的视频相比,观看更多明确披露的视频后,参与者的不确定性显著降低(平均±SE 评分分别为 5.3±0.2 与 5.7±0.2,P=0.032),满意度更高(5.6±0.2 与 5.2±0.2,P=0.010),而焦虑程度没有增加(状态特质焦虑量表状态评分变化:分别为 0.06±0.5 与 0.6±0.5,P=0.198)。自我效能(5.2±0.2 与 5.0±0.2,P=0.277)或讨论预先护理计划的意愿(2.7±0.1 与 2.7±0.1,P=0.240)方面没有显著差异。
在日本乳腺癌女性中,明确的预后披露比不披露产生了更好的结果。当亚洲癌症患者询问预后时,如果认为合适,临床医生可能会被鼓励尊重他们的意愿,并明确讨论预后。