3111University of Cagliari, Italy.
16777Universitat Rovira i Virgili, Spain.
Nurs Ethics. 2020 Sep;27(6):1418-1435. doi: 10.1177/0969733020916771. Epub 2020 May 14.
In cancer care, many clinical contexts still lack a good-quality patient-health professional communication about diagnosis and prognosis. Information transmission enables patients to make informed choices about their own healthcare. Nevertheless, disclosure is still an ethically challenging clinical problem in cancer care. High-quality care can be achieved by understanding the perspectives of others. The perspective of patients, their caregivers, physicians and nurses have seldom been simultaneously studied.
To investigate the phenomenon of diagnosis and prognosis-related communication as experienced by patients, their caregivers, and both their attending nurses and physicians, to enlighten meanings attached to communication by the four parties.
A qualitative study using interpretative phenomenological analysis was performed.
Purposive sampling of six patients, six caregivers, seven nurses and five physicians was performed in two oncological hospitals in Italy.
Local Ethics Committee approved the study. It was guided by the ethical principles of voluntary enrolment, anonymity, privacy and confidentiality.
Three main themes were identified: (a) the infinite range of possibilities in knowing and willing to know, (b) communication with the patient as a conflicting situation and (c) the bind of implicit and explicit meaning of communication.
The interplay of meanings attached by patients, their caregivers, and their attending oncologist and nurse to communication about diagnosis and prognosis revealed complexities and ambiguities not yet settled. Physicians still need to solve the ethical tensions in their caring relationship with patients to really allow them 'to choose with dignity and being aware of it'. Nurses need to develop awareness about their role in diagnosis and prognosis-related communication. This cognizance is essential not just to assure consistency of communication within the multi-disciplinary team but mostly because it allows and enables the moral agent to take its own responsibilities and be accountable for them.
在癌症护理中，许多临床情况下仍然缺乏关于诊断和预后的高质量医患沟通。信息传递使患者能够对自己的医疗保健做出明智的选择。然而，在癌症护理中，披露仍然是一个具有伦理挑战性的临床问题。通过了解他人的观点，可以实现高质量的护理。患者、他们的照顾者、医生和护士的观点很少同时进行研究。
调查患者、他们的照顾者以及他们的主治护士和医生所经历的与诊断和预后相关的沟通现象，阐明各方对沟通的意义。
采用解释现象学分析的定性研究。
在意大利的两家肿瘤医院，通过目的性抽样选择了 6 名患者、6 名照顾者、7 名护士和 5 名医生。
当地伦理委员会批准了这项研究。它遵循自愿注册、匿名、隐私和保密的伦理原则。
确定了三个主要主题：（a）了解和愿意了解的无限可能性，（b）与患者的沟通是一种冲突情况，（c）沟通的隐含和明确意义的束缚。
患者、他们的照顾者以及他们的主治医生和护士对诊断和预后沟通所附加的意义的相互作用揭示了尚未解决的复杂性和模糊性。医生仍然需要解决他们与患者的关怀关系中的伦理紧张，以真正允许他们“有尊严地选择并意识到这一点”。护士需要提高对他们在诊断和预后相关沟通中的角色的认识。这种认知不仅对确保多学科团队内沟通的一致性至关重要，而且主要是因为它允许和使道德代理人承担起自己的责任并对其负责。
