Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada.
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
BMC Cancer. 2020 Apr 30;20(1):364. doi: 10.1186/s12885-020-06821-5.
Women with ductal carcinoma in situ (DCIS) report poor patient-clinician communication, and long-lasting confusion and anxiety about their treatment and prognosis. Research shows that patient-centred care (PCC) improves patient experience and outcomes. Little is known about the clinician experience of delivering PCC for DCIS. This study characterized communication challenges faced by clinicians, and interventions they need to improve PCC for DCIS.
Purposive and snowball sampling were used to recruit Canadian clinicians by specialty, gender, years of experience, setting, and geographic location. Qualitative interviews were conducted by telephone. Data were analyzed using constant comparison. Findings were mapped to a cancer-specific, comprehensive PCC framework to identify opportunities for improvement.
Clinicians described approaches they used to address the PCC domains of fostering a healing relationship, exchanging information, and addressing emotions, but do not appear to be addressing the domains of managing uncertainty, involving women in making decisions, or enabling self-management. However, many clinicians described challenges or variable practices for all PCC domains but fostering a healing relationship. Clinicians vary in describing DCIS as cancer based on personal beliefs. When exchanging information, most find it difficult to justify treatment while assuring women of a good prognosis, and feel frustrated when women remain confused despite their efforts to explain it. While they recognize confusion and anxiety among women, clinicians said that patient navigators, social workers, support groups and high-quality information specific to DCIS are lacking. Despite these challenges, clinicians said they did not need or want communication interventions.
Findings represent currently unmet opportunities by which to help clinicians enhance PCC for DCIS, and underscore the need for supplemental information and supportive care specific to DCIS. Future research is needed to develop and test communication interventions that improve PCC for DCIS. If effective and widely implemented, this may contribute to improved care experiences and outcomes for women diagnosed with and treated for DCIS.
患有导管原位癌（DCIS）的女性报告称，她们与临床医生之间的沟通不畅，并且对治疗和预后感到困惑和焦虑的时间很长。研究表明，以患者为中心的护理（PCC）可以改善患者的体验和结果。但是，对于提供 DCIS 患者的 PCC 方面，临床医生的经验却鲜为人知。本研究描述了临床医生面临的沟通挑战，并确定了他们需要进行的干预措施，以改善 DCIS 的 PCC。
通过专业、性别、工作年限、地点和地理位置，采用有针对性的和滚雪球的抽样方法，招募加拿大临床医生。通过电话进行定性访谈。使用恒定性比较法对数据进行分析。研究结果被映射到癌症特定的综合 PCC 框架中，以确定改进的机会。
临床医生描述了他们用来解决促进治疗关系、交流信息和处理情绪的 PCC 领域的方法，但似乎没有解决管理不确定性、让女性参与决策或促进自我管理的领域。但是，许多临床医生描述了所有 PCC 领域的挑战或不同的做法，但以促进治疗关系为基础。临床医生根据个人信念将 DCIS 描述为癌症。在交流信息时，大多数人发现很难在保证良好预后的同时证明治疗的合理性，并且当他们尽力解释时，女性仍然感到困惑，这使他们感到沮丧。尽管他们认识到女性的困惑和焦虑，但临床医生表示，缺乏患者导航员、社会工作者、支持小组和针对 DCIS 的高质量信息。尽管面临这些挑战，但临床医生表示他们不需要或不需要沟通干预措施。
研究结果代表了目前尚未满足的机会，可以帮助临床医生增强 DCIS 的 PCC，并强调了针对 DCIS 提供补充信息和支持性护理的必要性。未来的研究需要开发和测试可以改善 DCIS 的 PCC 的沟通干预措施。如果有效且广泛实施，这可能有助于改善被诊断为患有和接受 DCIS 治疗的女性的护理体验和结果。
