Department of Political Science, Communication and International Relations, University of Macerata, Via Don Minzoni 22/A, 62100, Macerata, Italy.
Department of Human Sciences, University of Verona, Verona, Italy.
BMC Cancer. 2021 May 17;21(1):555. doi: 10.1186/s12885-021-08181-0.
The manner in which bad news is communicated in oncological contexts can affect patients' engagement, their coping strategies and therapeutic compliance. Although this topic has been broadly investigated since the nineties, to the best of our knowledge, little has been written about Italian patients' experiences and preferences concerning what the oncologists should disclose and how they should intimate patients about their health conditions in different stages of oncological disease.
In an attempt to fill this gap, an online self-report questionnaire was administered to a sample of Italian onco-haematological patients. Data were analysed both qualitatively (by a content analysis) and quantitatively (by descriptive analysis and Generalized Linear Mixed Model).
While the majority of patients elected to know the truth during their clinical course, a polarisation between those arguing that the truth be fully disclosed and those claiming that the truth be communicated in a personalised way was observed at the attitude level. Among demographic variables accounted for, age seems to most affect patients' preferences. Indeed, younger Italian patients decidedly reject concealment of the truth, even when justified by the beneficence principle. This result could be a reaction to some protective and paternalistic behaviours, but it could even reflect a relation according to which the more the age increases the more the fear of knowing rises, or an intergenerational change due to different ways of accessing the information. The qualitative analysis of the final open-ended question revealed three main sources of problems in doctor-patient encounters: scarcity of time, absence of empathy and use of not-understandable language that makes it difficult for patients to assume a more active role.
The results of the present study, which represents a preliminary step in the subject investigation, will be deployed for the construction and validation of a more sophisticated questionnaire. Better awareness of the Italian onco-haematological patients' preferences concerning bad news communication and truth-telling could be useful in adopting more suitable medical practices and improving doctor-patient relationships.
在肿瘤学背景下传达坏消息的方式会影响患者的参与度、应对策略和治疗依从性。尽管自 90 年代以来，这个话题已经被广泛研究，但据我们所知，关于肿瘤学家在肿瘤疾病的不同阶段应该向患者透露什么以及应该如何告知患者他们的健康状况，意大利患者的经验和偏好方面的研究甚少。
为了填补这一空白，我们向一组意大利肿瘤血液病患者发放了一份在线自我报告问卷。数据同时进行了定性（内容分析）和定量（描述性分析和广义线性混合模型）分析。
虽然大多数患者在临床过程中选择了解真相，但在态度层面上观察到了一种两极分化，即一方认为应该完全披露真相，另一方则认为应该以个性化的方式传达真相。在考虑到的人口统计学变量中，年龄似乎对患者的偏好影响最大。事实上，年轻的意大利患者坚决反对隐瞒真相，即使这是出于善意原则。这一结果可能是对一些保护和家长式行为的反应，但也可能反映出一种关系，即年龄越大，对了解真相的恐惧就越大，或者是由于获取信息的方式不同而导致的代际变化。对最终开放式问题的定性分析揭示了医患接触中三个主要问题来源：时间不足、缺乏同理心以及使用难以理解的语言，这使得患者难以发挥更积极的作用。
本研究结果代表了该主题研究的初步步骤，将用于构建和验证更复杂的问卷。更好地了解意大利肿瘤血液病患者对不良消息传达和说实话的偏好，有助于采用更合适的医疗实践和改善医患关系。
