Lyons Mavis S, Baker Clara, Chaput Genevieve, Finelli Antonio, Kupets Rachel, Look Hong Nicole J, Wright Frances C, Gagliardi Anna R
Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
BMJ Open. 2025 Jan 2;15(1):e087484. doi: 10.1136/bmjopen-2024-087484.
We explored how to improve communication about low-risk lesions including labels, language and other strategies.
Qualitative description and thematic analysis to examine the transcripts of telephone interviews with patients who had low-risk lesions and physicians; and mapping to Communication Accommodation Theory to interpret themes.
Canada PARTICIPANTS: 15 patients: 6 (40%) bladder, 5 (33%) prostate and 4 (27%) cervix lesions; and 13 physicians: 7 (54%) cervix, 3 (23%) bladder and 3 (23%) prostate lesions.
Patient and physician views of labels, language and other strategies to improve communication about low-risk lesions.
Patients and clinicians held discordant views about low-risk lesion label impact, preferences and rationale. All labels prompted confusion and anxiety among patients. In contrast, physicians perceived that patients understood that labels they used across all label categories (abnormal, precursor-to-cancer and cancer) implied low risk for cancer progression. Patients preferred abnormal cells, particularly when first learning of their diagnosis, and desired additional information to distinguish their diagnosis from cancer and justify treatment. In contrast, physicians favoured precursor-to-cancer and cancer labels out of habit, to match labels that patients saw elsewhere (online, charts) and to convince patients to attend follow-up and treatment visits. However, patients and physicians largely agreed on the need for 16 strategies that could improve communication about low-risk lesions including language (eg, plain language, situate low-risk lesions on cancer spectrum) and complementary communication strategies (eg, longer appointments, visual aids, connect patients with support services or groups).
The findings build on prior research by revealing that modifying labels is not the only or best strategy needed to improve communication about low-risk lesions. Ongoing research should examine how best to implement the strategies recommended by patients and physicians.
我们探讨了如何改善关于低风险病变的沟通，包括标签、语言及其他策略。
采用定性描述和主题分析，对患有低风险病变的患者和医生的电话访谈记录进行研究；并运用沟通顺应理论来解释主题。
加拿大
15名患者，其中6名（40%）患有膀胱病变，5名（33%）患有前列腺病变，4名（27%）患有宫颈病变；13名医生，其中7名（54%）处理宫颈病变，3名（23%）处理膀胱病变，3名（23%）处理前列腺病变。
患者和医生对用于改善低风险病变沟通的标签、语言及其他策略的看法。
患者和临床医生对低风险病变标签的影响、偏好及理由存在不一致的看法。所有标签都会引发患者的困惑和焦虑。相比之下，医生认为患者理解他们在所有标签类别（异常、癌前病变和癌症）中使用的标签意味着癌症进展风险较低。患者更喜欢“异常细胞”这个表述，尤其是在刚得知诊断结果时，并且希望获得更多信息以将自己的诊断与癌症区分开来，并为治疗提供依据。相比之下，医生出于习惯更倾向于使用“癌前病变”和“癌症”标签，以与患者在其他地方（在线、图表）看到的标签相匹配，并说服患者接受后续随访和治疗。然而，患者和医生在很大程度上都认同需要16种策略来改善关于低风险病变的沟通，这些策略包括语言方面（如使用通俗易懂的语言、在癌症谱系中定位低风险病变）和辅助沟通策略（如延长预约时间、使用视觉辅助工具、为患者联系支持服务或团体）。
这些发现基于先前的研究，揭示了修改标签并非改善低风险病变沟通所需的唯一或最佳策略。正在进行的研究应探讨如何最好地实施患者和医生推荐的策略。
