Sasako M
Dept. of Surgical Oncology, National Cancer Center Hospital, Japan.
Gan To Kagaku Ryoho. 1996 Jan;23(2):146-50.
According to the survey in the spring, 1995 of the Minister of Health and Welfare, only 20% of recently died patients had been told the truth, having cancer, in Japan. This suggest that most of clinical trials on cancer in Japan involved patients without real Informed consent (IC) from patients themselves. Recent effort of the Japanese Clinical Oncology Group are breaking through this situation. In the first part, principles of IC in cancer patients and IC in trials were explained. Then the results of a questionnaire are shown. From my personal experience of over 700 patients told the truth, all that doctors should tell to patients in western countries could be told without causing troubles even in Japan. The results of the questionnaire answered by 388 patients of various cancers treated by the author, showed clearly the feasibility of telling the truth to Japanese cancer patients. This has long been regarded impossible or unacceptable. Only 2% of them regretted to be told the truth, only 7% did not desire to know the prognosis, more than 90% wanted to be told that they have recurrence when they would have recurrence. Even when they would be incurable, 66% of them required to be told so and only 16% did not. In such difficult situation, 36% would insist anticancer treatment, while 41% would prefer best supportive care. No one but patients themselves can make this choice.
根据厚生省1995年春季的调查,在日本,最近去世的患者中只有20%被告知自己患有癌症这一实情。这表明日本大多数癌症临床试验所涉及的患者并未真正获得患者本人的知情同意(IC)。日本临床肿瘤学组最近的努力正在突破这种局面。第一部分阐述了癌症患者的知情同意原则以及试验中的知情同意原则。然后展示了一份问卷调查的结果。根据我向700多名患者告知实情的个人经验,在西方国家医生应该告知患者的所有情况,即便在日本告知也不会引发问题。作者对388名患有各种癌症的患者进行问卷调查的结果,清楚地表明了向日本癌症患者告知实情的可行性。长久以来,这一直被认为是不可能或不可接受的。他们中只有2%后悔被告知实情,只有7%不想知道预后情况,超过90%的患者希望在复发时被告知自己复发了。即便他们的病无法治愈,66%的患者要求被告知,只有16%的患者不希望被告知。在如此艰难的情况下,36%的患者会坚持进行抗癌治疗,而41%的患者会选择最佳支持治疗。除了患者本人,没有人能做出这个选择。