血液科医师如何与慢性淋巴细胞白血病患者沟通?

C. Karamanidou, A. Xochelli, P. Ghia, K. Stamatopoulos
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摘要

慢性淋巴细胞白血病(CLL)是一种慢性血液系统恶性肿瘤,具有很大的异质性和不可预测的临床病程。欧洲慢性淋巴细胞白血病研究计划(ERIC)在其慢性淋巴细胞白血病患者授权计划的背景下,进行了一项研究,探索血液学家的沟通经验。对希腊治疗慢性淋巴细胞白血病患者的血液学家进行了30次半结构化访谈。采用归纳主题定性分析揭示了3个主要主题:(i)信息披露包括“协商披露水平”,“文化观念的力量”,“对被判有罪的恐惧”,“对患者的恐惧”和自己的情绪;(ii)医疗决策,其中描述了“平衡自主和慈善”,“考虑病人的喜好”和“坚持实践指南”;(iii)情感支持,包括“评估情绪困扰”、“识别和调节患者情绪”和“维持支持关系”。总之,医生意识到沟通的重要性及其对慢性淋巴细胞白血病患者的潜在影响。他们使用广泛的传播策略,服务于他们必须实现的传播目标的多样性。然而,大多数医生都没有接受过与病人互动的正规教育。目前的研究结果强调,需要制定具体的沟通协议、指导和培训,以使医生能够克服CLL固有的挑战。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
How do Hematologists Communicate with Patients Suffering from Chronic Lymphocytic Leukemia?
Chronic Lymphocytic Leukemia (CLL) is a chronic hematologic malignancy with great heterogeneity and unpredictable clinical course. The European Research Initiative on CLL (ERIC), in the context of its CLL Patient Empowerment Program, conducted a study exploring hematologists’ experience of communication. Thirty semi-structured interviews were conducted with hematologists caring for CLL patients in Greece. Inductive thematic qualitative analysis was employed revealing 3 major themes: (i) disclosure of information encompassing ‘negotiating the level of disclosure’, ‘the power of cultural perceptions’, ‘fear of being held culpable’, ‘fear of patients’ and own emotions’; (ii) medical-decision making which described ‘balancing autonomy and beneficence’, ‘considering patients’ preferences’ and ‘adhering to practice guidelines’; (iii) emotional support which included ‘assessment of emotional distress’, ‘identifying and regulating patients’ emotions’ and ‘maintaining a supportive relationship’. In conclusion, physicians are aware of the importance of communication and its potential impact on CLL patients. They use a wide range of communication strategies which serve the diversity of communication goals they must achieve. However, the majority have not received formal education on patient interactions. Present findings highlight the need for specific communication protocols, guidance and training that will empower physicians to overcome challenges, inherent to the nature of CLL.
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