医生知道而患者不知道的情况吗？一项关于肺癌医患沟通的调查。

Do doctors know when their patients don't? A survey of doctor-patient communication in lung cancer.

作者信息

Quirt C F, Mackillop W J, Ginsburg A D, Sheldon L, Brundage M, Dixon P, Ginsburg L

机构信息

Department of Oncology, Queen's University, Kingston Regional Cancer Centre, Ontario, Canada.

出版信息

Lung Cancer. 1997 Aug;18(1):1-20. doi: 10.1016/s0169-5002(97)00048-2.

DOI:10.1016/s0169-5002(97)00048-2

PMID:9268944

Abstract

OBJECTIVES

a) To determine how much patients with recently diagnosed lung cancer know about their illness and its treatment, and b) to find out if doctors know what their patients know and what they don't.

PATIENTS AND METHODS

One hundred patients with recently diagnosed lung cancer, who were undergoing radiotherapy or chemotherapy, were interviewed to determine their view of their diagnosis, the extent of the cancer, the intent of treatment, and the risks and benefits of treatment. Their attending physicians' view were elicited contemporaneously, using a self-administered questionnaire. The principle outcome measure of the study was the level of agreement between the views of the patients and the doctors about the disease, the treatment, and the prognosis. Concordance between doctors' and patients' views was expressed in terms of percentage agreement, and Kappa (kappa).

RESULTS

Ninety-nine percent of the patients knew that they had lung cancer. Sixty-four percent (64%) agreed with their doctor about the extent of the disease (kappa = 0.48). Most of those who disagreed underestimated the extent of their cancer. Seventy-two percent (72%) agreed with their doctor about the intent of treatment (kappa = 0.49). Thirty-six percent (36%) agreed with their doctors about their probability of cure, (kappa = 0.17): most of those who disagreed systematically overestimated it. Sixty-eight patients were receiving palliative treatment. Of these, 56% agreed with their doctor about the probability of symptomatic benefit (kappa = 0.42), but only 14% agreed with their doctor about the probability that the treatment would prolong life (kappa = 0.06). Doctors frequently failed to recognize their patients' misconceptions about the intent of treatment and the prognosis.

CONCLUSION

Many patients did not understand their situation well enough to make a truly autonomous treatment decision, and their doctors often failed to recognize this.

摘要

目的

a）确定近期诊断为肺癌的患者对其病情及治疗的了解程度，b）了解医生是否知晓患者所了解和不了解的情况。

患者与方法

对100例近期诊断为肺癌且正在接受放疗或化疗的患者进行访谈，以确定他们对诊断、癌症范围、治疗目的以及治疗风险和益处的看法。同时，使用自填式问卷收集其主治医生的看法。该研究的主要结局指标是患者和医生对疾病、治疗及预后看法的一致程度。医生与患者看法的一致性用百分比一致性和Kappa值表示。

结果

99%的患者知道自己患有肺癌。64%的患者与医生对疾病范围的看法一致（Kappa = 0.48）。大多数意见不一致的患者低估了自己癌症的范围。72%的患者与医生对治疗目的的看法一致（Kappa = 0.49）。36%的患者与医生对治愈可能性的看法一致（Kappa = 0.17）：大多数意见不一致的患者系统性地高估了治愈可能性。68例患者正在接受姑息治疗。其中，56%的患者与医生对症状改善可能性的看法一致（Kappa = 0.42），但只有14%的患者与医生对治疗延长生命可能性的看法一致（Kappa = 0.06）。医生常常未能认识到患者对治疗目的和预后存在误解。