生物谷報(bào)道：在治療過程中,，醫(yī)生對(duì)待病人的態(tài)度對(duì)療效有很大影響，有時(shí)甚至?xí)^醫(yī)學(xué)治療效果,。但是,，美國杜克大學(xué)研究人員卻發(fā)現(xiàn)，腫瘤醫(yī)生和患者之間基本上沒有情感的交流,，這一研究結(jié)果發(fā)表在最新出版的《臨床腫瘤學(xué)雜志》（Journal of Clinical Oncology）上,。
良言一句三冬暖,。詹姆士·塔斯克博士是杜克大學(xué)安寧關(guān)懷中心主任，他認(rèn)為：“腫瘤醫(yī)生的作用是絕對(duì)的,。”研究人員也支持這樣的觀點(diǎn),，即一位腫瘤專家?guī)拙錅嘏w貼的話對(duì)癌癥患者了解病情、配合治療有很大的幫助,。
《紐約時(shí)報(bào)》講述了一個(gè)真實(shí)的故事,。4年前，丹尼斯同時(shí)被查出患上兩種癌癥,。在一年多的時(shí)間里,，她需要進(jìn)行一次大手術(shù)和幾次小手術(shù)，并同時(shí)接受化學(xué)治療和放射性治療,。在這段時(shí)間里,，她的體重減少了30磅，化療導(dǎo)致她的頭發(fā)脫落,、指甲破裂,、眼睛干燥、嘴唇疼痛,，夜不能寐,，她變得瘦骨嶙峋、弱不禁風(fēng),。放射性治療灼傷了她的皮膚,，她在出門時(shí)不得不在脖子上系一條絲帶。
丹尼斯必須經(jīng)常去看她的兩位醫(yī)生,。放射性治療的醫(yī)生會(huì)用自己的手臂摟著她虛弱的肩膀,，帶她到走廊上，兩人仿佛是老朋友,。而腫瘤醫(yī)生則會(huì)密切注視治療的副作用，提醒她治療已有了好的效果,，頭發(fā)會(huì)重新長出來,。
丹尼斯無限感激這兩位女醫(yī)生給她的溫暖和鼓勵(lì)，她完全相信她們和她們提出的建議?，F(xiàn)在,，已經(jīng)康復(fù)的丹尼斯說，醫(yī)生們的同情心在幫助她渡過難關(guān),、戰(zhàn)勝疾病的過程中發(fā)揮了巨大作用,。
為了研究患者和醫(yī)生間的情緒交流問題，塔斯克和同事記錄了51位腫瘤學(xué)家和270位晚期癌癥患者之間的398次對(duì)話,，并仔細(xì)傾聽了患者向醫(yī)生述說情感的片段,，以及醫(yī)生的回應(yīng),。如果醫(yī)生回答：“我能想象這對(duì)你來說是多么可怕的事。”那么這樣的回應(yīng)是具有同情心的,，并允許患者繼續(xù)表達(dá)自己的情感,。但是，如果醫(yī)生回答：“給我們時(shí)間,，我們正在處理你的問題,。”那么這實(shí)際上是阻止患者繼續(xù)表達(dá)感情的信號(hào)。
研究人員發(fā)現(xiàn),，只有22%的醫(yī)生以同情的方式回應(yīng)患者的憂慮,，而且男性醫(yī)生比女性醫(yī)生表現(xiàn)得更糟：48%的男性醫(yī)生從不鼓勵(lì)患者表達(dá)情緒，而這樣做的女醫(yī)生只有20%,。更令人吃驚的是,，只有37%的患者會(huì)向醫(yī)生表達(dá)情緒。塔斯克說：“這相當(dāng)不正常,，因?yàn)樗麄兌际峭砥诎┌Y患者,。”
目前還不清楚患者為什么有這樣的表現(xiàn)，但塔斯克認(rèn)為,，患者可能根本就不期望從醫(yī)生那里得到同情,。當(dāng)患者和醫(yī)生都是女性時(shí)，這種交流才最有可能發(fā)生,，年輕的醫(yī)生也更具同情心,。
塔斯克說，一位具有同情心的醫(yī)生在看到一位新患者時(shí)會(huì)說：“告訴我你對(duì)自己的病有多少了解,。”當(dāng)患者流淚時(shí),，這位醫(yī)生會(huì)停下來，直至他們之間能繼續(xù)交流,。相反,，當(dāng)患者說“我害怕”時(shí)，有的醫(yī)生則會(huì)用“科學(xué)借口”來阻止這種情緒的交流：“這種情況我們看得多了,。”
塔斯克認(rèn)為,，醫(yī)生們不是缺乏同情心，而是困于表達(dá),。這篇研究論文的第一作者Kathryn I. Pollak是杜克大學(xué)的社會(huì)心理學(xué)家,，她說：“腫瘤醫(yī)生深切地關(guān)心他們的病人，一聽錄音磁帶就明白了,。”癌癥患者和腫瘤醫(yī)生間有一種特殊的密切關(guān)系,，因?yàn)榛颊呤窃跒樯娑窢帯?br />
即使如此，腫瘤醫(yī)生也會(huì)忽略一些悲痛的信號(hào)，特別是那些間接表達(dá)的信號(hào),。比如,，患者可能想知道腫瘤有多大了，醫(yī)生回答說：“只有幾毫米,。”但患者真正想知道的是：腫瘤究竟是變大還是變小了,，我會(huì)死嗎？
塔斯克說,，好消息是絕大多數(shù)醫(yī)生都受到了這樣的教育：以更友善的方式回應(yīng)患者,。簡而言之，只要有同情心就足夠了,。研究人員并不建議過于寬泛的意見咨詢或醫(yī)生與患者間無休無止的對(duì)話,。
患者向醫(yī)生表達(dá)害怕和痛苦的心情，并尋找醫(yī)生的同情和幫助,，這是合理的要求,。“當(dāng)你說出自己的情感時(shí)，實(shí)際上會(huì)讓自己更容易受到傷害,。”Pollak說：“但我仍然建議患者盡可能直接向醫(yī)生傾述,。”
生物谷推薦原始出處：
Journal of Clinical Oncology, Vol 25, No 36 (December 20), 2007: pp. 5748-5752
Oncologist Communication About Emotion During Visits With Patients With Advanced Cancer
Kathryn I. Pollak, Robert M. Arnold, Amy S. Jeffreys, Stewart C. Alexander, Maren K. Olsen, Amy P. Abernethy, Celette Sugg Skinner, Keri L. Rodriguez, James A. Tulsky
From the Duke Comprehensive Cancer Center, Cancer Prevention, Detection, and Control Research Program; the Department of Community and Family Medicine; the Department of Biostatistics and Bioinformatics; the Department of Medicine; the Center for Palliative Care, Duke University Medical Center; the Center for Health Services Research, Durham Veterans Affairs Medical Center, Durham, NC; the Division of General Internal Medicine, Department of Medicine; the Institute for Doctor-Patient Communication; the Institute to Enhance Palliative Care, University of Pittsburgh School of Medicine; and the Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
Address reprint requests to Kathryn I. Pollak, PhD, Duke University Medical Center, Community and Family Medicine, 2424 Erwin Rd, Suite 602, Durham, NC 27705; e-mail: [email protected]
Introduction: Cancer care involves addressing patient emotion. When patients express negative emotions, empathic opportunities emerge. When oncologists respond with a continuer statement, which is one that offers empathy and allows patients to continue expressing emotions, rather than with a terminator statement, which is one that discourages disclosure, patients have less anxiety and depression and report greater satisfaction and adherence to therapy. We studied whether oncologist traits were associated with empathic opportunities and empathic responses.
Patients and Methods: We audio-recorded 398 clinic conversations between 51 oncologists and 270 patients with advanced cancer; oncologists also completed surveys. Conversations were coded for the presence of empathic opportunities and oncologist responses. Analyses examined the relationship with oncologists' demographics, self-reported confidence, outcome expectancies, and comfort to address social versus technical aspects of care.
Results: In 398 conversations, 37% contained at least one empathic opportunity; the range was 0 to 10, and the total empathic opportunities was 292. When they occurred, oncologists responded with continuers 22% of the time. Oncologist sex was related to the number of empathic opportunities; female patients seen by female oncologists had the most empathic opportunities (P = .03). Younger oncologists (P = .02) and those who rated their orientation as more socioemotional than technical (P = .03) were more likely to respond with empathic statements.
Conclusion: Oncologists encountered few empathic opportunities and responded with empathic statements infrequently. Empathic responses were more prevalent among younger oncologists and among those who were self-rated as socioemotional. To reduce patient anxiety and increase patient satisfaction and adherence, oncologists may need training to encourage patients to express emotions and to respond empathically to patients' emotions.
Supported by National Cancer Institute Grant No. R01CA100387.
Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
