家属对癌症晚期患者病情告知及态度的质性研究

A Qualitative Study on Bad News Delivery by Advanced Cancer Patients' Family Members and Their Attitude

目的了解家属对癌症晚期患者的病情告知情况及态度,为社区临终关怀服务提供帮助与指导。方法2013年4—9月,采用立意取样法选取12位癌症晚期患者家属进行深度访谈并录音,用质性研究的现象学分析法收集整理资料、分析提炼主题。结果 10位癌症晚期患者获知自己病情,其主要原因是患者主动要求告知病情;家属受不同因素影响告知患者病情。并发现其不同告知方法得到不同的告知效果。2位癌症晚期患者未被告知病情,发现其主要原因的2个主题:告知病情无实际意义和担心承受巨大的心理和精神压力。结论人们对告知观念悄然发生改变,由起初的是否告知转变为现在的如何告知,即选择最佳的告知策略将成为值得研究的技术性问题。

Objective To acquire the status of bad news delivery by family members to advanced cancer patients and their attitude,as well provide advices and instructions for end of life care in community. Methods 12 patients with advanced cancer were selected by purposive sampling,their family members were interviewed in depth,and the interviews were recor-ded. Phenomenological analysis was applied to analyze the collected data and summarize the themes. Results 10 patients with ad-vanced cancer were informed of their illness under their own request. Different factors influenced family members delivering the bad news to the patients. It is shown that different approaches of delivering the bad news will result in different outcome. 2 patients with advanced cancer were not informed of the situation,2 themes of main reasons were identified：delivery of the bad news would not change the reality and the family members were worried about bearing considerable psychological and mental pres-sure. Conclusion People＇s perception of delivering the bad news has subtly changed from ‘tell or not＇ to ‘how to tell＇,choosing the best strategy to deliver bad news will become a technical problem worth to be studied.