Strauss R P, Sharp M C, Lorch S C, Kachalia B
Department of Dental Ecology, University of North Carolina at Chapel Hill, School of Dentistry 27599-7450, USA.
Pediatrics. 1995 Jul;96(1 Pt 1):82-9.
Physicians often are called on to deliver "bad news" in the form of a diagnosis with unhappy implications. Few guidelines exist for practitioners who wish to meet patient and family expectations for clear and caring communication. To develop recommendations for physicians, this study was undertaken to document how biologic parents of children born with a specific, non-life-threatening birth defect perceive the encounter with a physician during which they were informed of their children's diagnosis. The study also examines parental preferences for how this communication might best be managed and compares those with parent reports of their actual experiences.
Biologic parents of children born with cleft lip and/or palate (n = 100) were studied with a self-administered questionnaire about the diagnostic encounter in which they rated theoretically derived dimensions of physician communication. Their experiences, as well as their preferences for communication in a hypothetical case, were compared through the use of ratings and open-ended qualitative narratives.
Parents learned the diagnosis at birth (90%) from a physician (96%). Many report positive experiences, but there are significant differences between what parents experienced and what they desire in the informative interview. Parents wanted more opportunity to talk and to show their feelings and wanted the physician to try harder to make them feel better. As compared with their experiences, parents indicated a desire to have more information and more of a discussion about the possibility of mental retardation. They wanted the physician to show more caring and confidence, and wanted more referral to other parents, than they had experienced. Dimensions of physician behavior were more positively perceived by parents who were informed by a physician whom they felt they knew well.
It is possible for physicians to effectively deliver bad news, such as the diagnosis of a birth defect, to parents. This study suggests specific communicative and educational approaches that are likely to improve parental satisfaction with such physician communications.
医生常常需要以带有不良影响的诊断结果这种形式来传达“坏消息”。对于那些希望满足患者及其家属对清晰且关怀备至的沟通期望的从业者而言，几乎没有相关指导方针。为了给医生制定建议，开展了这项研究，以记录患有特定的、非危及生命的出生缺陷的孩子的亲生父母在被告知孩子诊断结果时，对与医生会面的感受。该研究还考察了父母对于这种沟通最佳管理方式的偏好，并将其与父母对实际经历的报告进行比较。
对100名唇腭裂患儿的亲生父母进行了研究，采用一份关于诊断会面的自填式问卷，让他们对理论上推导出来的医生沟通维度进行评分。通过评分和开放式定性叙述，比较了他们的经历以及在一个假设案例中对沟通的偏好。
90%的父母在孩子出生时从医生那里得知诊断结果（96%）。许多父母报告了积极的经历，但在信息告知面谈中，父母的实际经历与他们的期望之间存在显著差异。父母希望有更多机会交谈、表达感受，希望医生更努力让他们感觉好一些。与实际经历相比，父母表示希望获得更多信息，并就智力发育迟缓的可能性进行更多讨论。他们希望医生表现出更多关怀和信心，希望能比实际经历中获得更多与其他父母的交流推荐。那些由他们感觉很熟悉的医生告知诊断结果的父母，对医生行为维度的评价更为积极。
医生有可能有效地向父母传达诸如出生缺陷诊断这样的坏消息。这项研究提出了一些具体的沟通和教育方法，这些方法可能会提高父母对这类医生沟通的满意度。
