医患交流坏消息告知研究:回顾与展望  

Doctor-patient Bad News Delivery:Review and Prospect

作　　者：李芳[1] LI Fang(School of Health Humanities,Peking University,Beijing 100191,China)

机构地区：[1]北京大学医学人文学院,北京100191

出　　处：《云南师范大学学报（哲学社会科学版）》2020年第4期33-41,共9页Journal of Yunnan Normal University：Humanities and Social Sciences Edition

基　　金：国家社科基金重点项目“当代中国‘死亡话语’及发展考察”(19AYY001)。

摘　　要：近年来,医患交流中的坏消息告知逐渐成为医学、社会学、语言学等领域的跨学科研究热点。坏消息告知历来被认为是医务人员在临床工作中遇到的最具有挑战性的沟通情境。文章回顾了国内外医患交流坏消息告知相关研究。主要发现有:从研究主题和内容来看,目前世界范围内医患交流坏消息告知研究多数围绕癌症患者和临终患者群体展开,研究范式可以被划分为"宏观话语外围研究"和"微观话语本体研究"两大类;来自医学学科的"宏观话语外围研究"占比较大,且已经在坏消息告知环境、告知模式、患者对坏消息告知的喜好等方面取得了较为系统、实用的研究结果,并在一定程度上取得了跨文化、跨地域的共性发现;以语言学和会话分析为代表的"微观话语本体研究"从20世纪90年代起逐渐在国外产生一定的影响,而在中国则是在20年后才刚刚起步。微观话语研究有望从跨学科角度揭示并探讨坏消息告知会话的序列结构和话轮设计;宏观与微观视角研究相结合有望为临床医务人员提供直观、具体、实用的言语层面的指导。基于上述回顾,文章对未来相关研究提出了建议和展望。In recent years,doctor-patient bad news delivery has become a focus of cross-disciplinary study,including medicine,sociology and linguistics.Bad news delivery has long been recognized as one of the most challenging communicative acts in clinical encounters.This article has reviewed studies on doctor-patient bad news delivery at home and abroad.The main findings are as follows:1)Most studies have focused on the population of patients with cancer or within end-of-life stages,which can be categorized under two research paradigms:"macro-level research on non-discourse elements"and"micro-analysis of discourse itself".2)Macro-level research,mainly conducted by scholars from medical fields and public health,ranks a lot higher than micro-analysis in terms of quantity and have yielded considerable research findings which to some degree represent the general patterns on bad news delivery and patient preferences across cultures.3)Micro-analysis,including conversation analysis and discourse analysis from the field of sociology and linguistics,has been adopted to study bad news delivery conversations since the 1990 s abroad.However,it was not until 20 years after that studies using micro-analysis started to appear in China.Micro-analysis on bad news delivery helps to reveal and explore the overall and sequential structure of conversations so as to show how bad news is,could be and should be delivered at the linguistic level.Based on the review,this article has generated some suggestions for future research in this field.

关 键 词：坏消息 消息告知 会话分析 序列 微观分析 

分 类 号：H0-05[语言文字—语言学]