School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
Royal College of Surgeons in Ireland, Dublin, Ireland.
BMJ Support Palliat Care. 2021 Jun;11(2):128-132. doi: 10.1136/bmjspcare-2020-002700. Epub 2021 Mar 24.
Requesting that serious diagnoses be concealed from patients, a widespread phenomenon in many cultures, presents a professional dilemma. Practical and sensitive communication strategies are needed.
In this paper, we use analysis of the existing literature to develop a communication tool for practitioners facing requests for diagnostic non-disclosure. Our approach builds on existing strategies, in providing a mnemonic communication tool, permitting more than one outcome, and focusing on the need for mutual understanding and cooperation.
Existing work on this dilemma highlights the need to appreciate the family's standpoint, affirm their benevolent intentions and correct misperceptions. To this end, we have developed a mnemonic tool, 'ARCHES', to be used in situations where the family has requested diagnostic non-disclosure. The model has six stages: acknowledge the request for non-disclosure, build the relationship, find common ground, honour the patient's preferences and outline the harm of non-disclosure, provide emotional support and devise a supportive solution.
Facing requests for diagnostic non-disclosure is a challenge of communication. The dilemma is particularly marked when practising across cultures. Our model gives a structure for building rapport with the family and realigning their misperceptions while upholding the patient's right to knowledge.
在许多文化中，请求向患者隐瞒严重诊断是一种普遍现象，这给专业人员带来了困境。需要实用且敏感的沟通策略。
在本文中，我们使用对现有文献的分析，为面临诊断保密请求的从业者开发沟通工具。我们的方法建立在现有策略的基础上，提供了一个助记符沟通工具，允许出现多种结果，并侧重于相互理解和合作的需求。
关于这一困境的现有工作强调了需要理解家庭的立场，肯定他们的善意意图和纠正误解。为此，我们开发了一个助记符工具“ARCHES”，用于家庭请求诊断保密的情况。该模型有六个阶段：承认保密请求，建立关系，寻找共同点，尊重患者的偏好并概述保密的危害，提供情感支持并设计支持性解决方案。
面对诊断保密请求是沟通的挑战。在跨文化实践中，这种困境尤为明显。我们的模型为与家庭建立融洽关系并重新调整他们的误解提供了结构，同时维护了患者的知情权。
