Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.
Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland.
PLoS One. 2019 Oct 29;14(10):e0224394. doi: 10.1371/journal.pone.0224394. eCollection 2019.
The communication of prognosis represents an ethical and clinical challenge in medical practice due to the inherent uncertain character of prognostic projections. The literature has stressed that the mode of communicating prognoses has an impact on patients' hope, which is considered to play a major role in adapting to illness and disability. In light of this, this study aims to explore health professionals' (HPs) perceptions of the role of hope in rehabilitation and to examine if and how they use strategies to maintain hope when discussing prognostic information with patients.
Eleven qualitative semi-structured interviews with a purposive sample of HPs were conducted at two rehabilitation clinics in the Canton of Ticino, Switzerland. The interviews were analyzed using thematic analysis.
The HPs perceive hope in rehabilitation as a double-edged sword. Three main strategies were identified to maintain hope while avoiding false hope: 1) giving space for self-evaluation; 2) tailoring the communication of prognostic information; and 3) supporting the patient in dealing with the prognosis. These strategies are particularly suitable when HPs consider that patients might not be ready to accept the prognosis, due to their expectations for recovery.
The strategies identified here support a person-centered approach to the communication of prognosis and are in line with existing protocols for the communication of unfavorable medical information. The findings emphasize the need for strengthening communication and inter-professional collaboration skills of rehabilitation HPs.
由于预后预测具有固有不确定性,因此在医疗实践中,预后的沟通是一个伦理和临床挑战。文献强调,沟通预后的方式会影响患者的希望,而希望被认为在适应疾病和残疾方面起着重要作用。有鉴于此,本研究旨在探讨卫生专业人员(HPs)对希望在康复中的作用的看法,并研究他们在与患者讨论预后信息时是否以及如何使用维持希望的策略。
在瑞士提契诺州的两家康复诊所,采用目的抽样法对 HPs 进行了 11 次定性半结构式访谈。使用主题分析对访谈进行了分析。
HPs 将康复中的希望视为一把双刃剑。确定了三种主要的维持希望而避免虚假希望的策略:1)为自我评估留出空间;2)调整预后信息的沟通;3)支持患者应对预后。当 HPs 认为由于患者对康复的期望,他们可能还没有准备好接受预后时,这些策略特别适用。
这里确定的策略支持以患者为中心的预后沟通方法,并且符合现有的不良医疗信息沟通协议。研究结果强调需要加强康复 HPs 的沟通和跨专业协作技能。