晚期乳腺癌中的坏消息与好消息告知：共情在信息回忆中的作用——一项观察性研究
Good versus bad news consultations in advanced breast cancer: the role of empathy in information recall - an observational study.
作者信息
van Vliet Liesbeth M, Leeuwenburgh Margot L R, Westendorp Janine, van Dulmen Sandra, de Jong Paul C, Stouthard Jacqueline M L
机构信息
Department of Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands
Department of Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands.
出版信息
BMJ Support Palliat Care. 2023 Mar 27. doi: 10.1136/spcare-2022-003938.
OBJECTIVE
We explored, in advanced breast cancer, whether: (1) patients recall less information following bad versus good news consultations; (2) empathy has a greater effect on recalled information following bad versus good news consultations.
METHODS
Observational study using audio-recorded consultations. Participants' recall of provided information about treatment options, aims/positive effects and side-effects was assessed. Clinician-expressed empathy and consultation type were determined. Regression analyses assessed associations between consultation type and recall, exploring moderating influences of clinician-expressed empathy.
RESULTS
For 41 consultations (18 bad news, 23 good news), recall data were completed; total recall (47% vs 73%, p=0.03) and recall about treatment options (67% vs 85%, p=0.08, trend) were significantly worse following bad news compared with good news consultations. Recall about treatment aims/positive effects (53% vs 70%, p=0.30) and side-effects (28% vs 49%, p=0.20) was not significantly worse following bad news. Empathy moderated the relationship between consultation type and total recall (p<0.01), recall about treatment options (p=0.03) and about aims/positive effects (p<0.01) but not about side-effects (p=0.10). Only following good news consultations empathy influenced recall favourably.
CONCLUSIONS
This explorative study suggests that in advanced cancer, information recall is especially impaired following bad news consultations, for which empathy does not improve remembered information.
目的
我们探讨了在晚期乳腺癌患者中：（1）与传达好消息的会诊相比，传达坏消息的会诊后患者对信息的回忆是否更少；（2）共情对传达坏消息与好消息的会诊后患者对信息的回忆影响是否更大。
方法
采用会诊录音进行观察性研究。评估参与者对提供的有关治疗方案、目标/积极效果和副作用的信息的回忆情况。确定临床医生表达的共情程度和会诊类型。回归分析评估会诊类型与回忆之间的关联，探讨临床医生表达的共情的调节作用。
结果
41次会诊（18次传达坏消息，23次传达好消息）的回忆数据完整；与传达好消息的会诊相比，传达坏消息的会诊后总体回忆（47%对73%，p=0.03）和关于治疗方案的回忆（67%对85%，p=0.08，有趋势性差异）明显更差。关于治疗目标/积极效果的回忆（53%对70%，p=0.30）和副作用的回忆（28%对49%，p=0.20）在传达坏消息后没有明显更差。共情调节了会诊类型与总体回忆（p<0.01）、关于治疗方案的回忆（p=0.03）以及关于目标/积极效果的回忆（p<0.01）之间的关系，但未调节与副作用回忆（p=0.10）之间的关系。仅在传达好消息的会诊后，共情对回忆有积极影响。
结论
这项探索性研究表明，在晚期癌症中，传达坏消息的会诊后信息回忆尤其受损，共情并不能改善记忆信息。
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