Department of Communication, Rutgers University, New Brunswick, NJ, USA.
Department of Communication, Rutgers University, New Brunswick, NJ, USA.
Patient Educ Couns. 2023 Sep;114:107791. doi: 10.1016/j.pec.2023.107791. Epub 2023 May 15.
This study examined the degree to which breast cancer patients' psychological well-being is facilitated through empathic provider communication. We explored symptom/prognostic uncertainty reduction as a mechanism through which provider communication influences patient psychological adjustment. Additionally, we tested if treatment status moderates this relationship.
Informed by uncertainty in illness theory, current (n = 121) and former (n = 187) breast cancer patients completed questionnaires about perceptions of their oncologists' empathy and their symptom burden, uncertainty, and adjustment to their diagnosis. Structural equation modeling (SEM) was conducted to test hypothesized relationships between perceived provider empathic communication, uncertainty, symptom burden, and psychological adjustment.
SEM supported the following: (1) higher symptom burden was associated with increased uncertainty and reduced psychological adjustment, (2) lower uncertainty was associated with increased adjustment, and (3) increased empathic communication was associated with lower symptom burden and uncertainty for all patients (χ(139) = 307.33, p < .001; RMSEA = .063 (CI .053, .072); CFI = .966; SRMR = .057). Treatment status moderated these relationships (Δχ = 264.07, Δdf = 138, p < .001) such that the strength of the relationship between uncertainty and psychological adjustment was stronger for former patients than for current patients.
Results of this study reinforce the importance of perceptions of provider empathic communication as well as the potential benefits of eliciting and addressing patient uncertainty about treatment and prognosis throughout the cancer care continuum.
Patient uncertainty should be a priority for cancer-care providers both throughout and post-treatment for breast cancer patients.
本研究考察了乳腺癌患者的心理健康在多大程度上得益于富有同理心的医护人员的沟通。我们探讨了症状/预后不确定性的降低作为一种机制，通过该机制，医护人员的沟通会影响患者的心理适应。此外，我们还测试了治疗状况是否调节了这种关系。
本研究以疾病不确定理论为指导，纳入了 121 名现患乳腺癌患者和 187 名既往乳腺癌患者，他们完成了有关其肿瘤医生同理心感知及其症状负担、不确定性和对诊断的适应情况的问卷。结构方程模型（SEM）用于测试感知到的提供者共情沟通、不确定性、症状负担和心理调整之间假设的关系。
SEM 支持以下观点：（1）较高的症状负担与增加的不确定性和降低的心理调整相关；（2）较低的不确定性与增加的调整相关；（3）所有患者的共情沟通增加与较低的症状负担和不确定性相关（χ(139) = 307.33，p < 0.001；RMSEA = 0.063（CI 0.053，0.072）；CFI = 0.966；SRMR = 0.057）。治疗状况调节了这些关系（Δχ = 264.07，Δdf = 138，p < 0.001），使得不确定性与心理调整之间的关系强度在前患者中强于现患者。
本研究结果强调了感知提供者共情沟通的重要性，以及在整个癌症护理连续体中引出和解决患者对治疗和预后的不确定性的潜在益处。
对于乳腺癌患者，医护人员应将患者的不确定性作为治疗期间和治疗后的重点。
