Holland J C, Geary N, Marchini A, Tross S
Cancer Invest. 1987;5(2):151-4. doi: 10.3109/07357908709018468.
In 1984, questionnaires were sent to members of the International Psycho-Oncology Society concerning the practice in their country with regard to revealing the diagnosis of cancer to patients, their opinion about the effect of their policy, and their impression of local trends and attitudes toward cancer. Data from 90 respondents from 20 countries revealed that use of the word "cancer" was often avoided in discussions with the patient. Words commonly substituted for cancer were those that implied a "swelling" (e.g., tumor, growth, lump), and "inflammation," or a pathophysiologic change (blood disease, precancerous, unclean tissue). Oncologists estimated that a low percentage (less than 40%) of their colleagues revealed the word cancer in Africa, France, Hungary, Italy, Japan, Panama, Portugal, and Spain. Oncologists from Austria, Denmark Finland, The Netherlands, New Zealand, Norway, Sweden, and Switzerland, estimated the percentage to be high (greater than 80%). However, in all countries, the majority of physicians tell the family the diagnosis. The majority (90%) reported a trend toward increased telling of the diagnosis, due to greater patient information and expectations, and increased physician openess in using the word cancer. Most (68%) felt that the overall effect of revealing the diagnosis was positive. While emotional distress was transiently greater when patients were told, there were positive effects concerning coping, compliance, tolerance of treatment, planning for future, communication with physicians and others, and improved prognosis. The transient negative effects were depression, anxiety, and anger. It is important to recognize that efforts to find the "correct" position about revealing or concealing cancer diagnosis must recognize that the language between doctor and patient is constrained by cultural norms. Communication is likely to be far less dependent upon the specific words used then upon the meaning that is conveyed by the doctor.
1984年，国际心理肿瘤学会向其成员发放了调查问卷，内容涉及他们所在国家向癌症患者告知诊断结果的做法、他们对自身政策效果的看法，以及他们对当地癌症趋势和态度的印象。来自20个国家的90名受访者的数据显示，在与患者讨论时，人们常常避免使用“癌症”这个词。通常用来替代癌症的词汇是那些暗示“肿胀”（如肿瘤、肿物、肿块）、“炎症”或病理生理变化（血液疾病、癌前病变、不干净的组织）的词。肿瘤学家估计，在非洲、法国、匈牙利、意大利、日本、巴拿马、葡萄牙和西班牙，只有一小部分（不到40%）同事会说出“癌症”这个词。来自奥地利、丹麦、芬兰、荷兰、新西兰、挪威、瑞典和瑞士的肿瘤学家估计这一比例较高（超过80%）。然而，在所有国家，大多数医生都会把诊断结果告诉患者家属。大多数人（90%）报告称，由于患者信息需求和期望增加，以及医生在使用“癌症”一词时更加开放，告知诊断结果的趋势有所增加。大多数人（68%）认为告知诊断结果的总体效果是积极的。虽然患者被告知时情绪困扰会暂时加剧，但在应对、依从性、对治疗的耐受性、未来规划、与医生及其他人的沟通以及改善预后方面都有积极影响。暂时的负面影响是抑郁、焦虑和愤怒。必须认识到，试图找到关于透露或隐瞒癌症诊断的“正确”立场时，必须认识到医患之间的语言受到文化规范的限制。沟通可能远不那么依赖于具体使用的词汇，而是更依赖于医生所传达的含义。
