Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Eupener Str. 129, 50933, Cologne, Germany.
J Cancer Res Clin Oncol. 2023 Jul;149(7):3859-3870. doi: 10.1007/s00432-022-04311-8. Epub 2022 Aug 23.
Receiving a cancer diagnosis significantly impacts patients' lives, and how the bad news is delivered influences patients' trajectory, psychosocial adjustment and openness to psycho-oncological support. We explored how patients' experiences, reactions and preferences were when receiving the news and which optimization recommendations can be made.
We conducted an exploratory qualitative study with patients who enrolled in the new integrated cross-sectoral psycho-oncological care programme 'isPO', being enrolled 12 months post-diagnosis. Data on the main issue (i.e. perception of the moment when the diagnosis is received) were collected via telephone interviews that were fully audiotaped and transcribed. Two independent coders conducted inductive content analyses using MAXQDA.
Out of 38 approached patients, 23 cancer patients with 13 different tumour entities participated. They had a mean age of 54.2 (SD 16.2); n = 17 (74%) were female. Three major themes with 14 corresponding subthemes emerged: (1) patients' experiences with the bad news delivery, including setting, mode, preparation and perceived needs; (2) patients' reactions to the bad news, such as shock, fear and helplessness, disbelief and denial, anger and feeling of injustice, thankfulness and depression; and (3) patients' receiving preferences, including psycho-oncological support, addressing informational needs, needs-driven comprehensive support and a competent multidisciplinary support team.
The quality of bad news delivery and addressing patients' needs should be strongly considered by physicians. We recommend integrating patients' perspective on the quality management processes of breaking bad news. For providing needs-centred high-quality care, applying existing guidelines and acquiring patient-centred communication skills are central.
癌症诊断会对患者的生活产生重大影响，不良消息的传递方式会影响患者的轨迹、心理社会适应和对心理肿瘤学支持的接受程度。我们探讨了患者在收到消息时的经历、反应和偏好，以及可以提出哪些优化建议。
我们对新的跨部门综合心理肿瘤学护理计划“isPO”中登记的 12 个月后确诊的患者进行了一项探索性定性研究。通过电话访谈收集有关主要问题（即诊断时的感知）的数据，访谈全程录音并转录。两名独立的编码员使用 MAXQDA 进行了归纳内容分析。
在联系的 38 名患者中，有 23 名癌症患者（13 种不同的肿瘤实体）参与了研究。他们的平均年龄为 54.2（标准差 16.2）；n=17（74%）为女性。出现了 3 个主要主题和 14 个相应的子主题：（1）患者对不良消息传递的体验，包括环境、模式、准备和感知需求；（2）患者对不良消息的反应，如震惊、恐惧和无助、怀疑和否认、愤怒和不公正感、感激和抑郁；（3）患者的接收偏好，包括心理肿瘤学支持、满足信息需求、需求驱动的综合支持和有能力的多学科支持团队。
医生应该充分考虑不良消息传递的质量和满足患者的需求。我们建议将患者对不良消息传递质量管理过程的观点纳入其中。为了提供以需求为中心的高质量护理，应用现有的指南和获取以患者为中心的沟通技巧是至关重要的。
