基于沟通模型的晚期癌症患者病情告知策略的构建研究  

A study on the construction of communication strategies for informing patients with advanced cancer

作　　者：刘雨童 陆箴琦 张晓菊 黄喆 Liu Yutong;Lu Zhenqi;Zhang Xiaoju;Huang Zhe(Department of Nursing,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China;Department of Palliative Care,Fudan University Shanghai Cancer Center,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院护理部、复旦大学上海医学院肿瘤学系,上海200032 [2]复旦大学附属肿瘤医院姑息治疗科,上海200032

出　　处：《中国实用护理杂志》2024年第13期1000-1008,共9页Chinese Journal of Practical Nursing

基　　金：复旦大学循证护理中心循证护理全链条创新研究项目(FNDGJ202009);复旦大学-复星护理科研基金(FNF202014)。

摘　　要：目的基于两种国内外广泛使用的沟通模型构建晚期癌症患者病情告知策略及实施方法,以减轻临床病情告知难度。方法于2022年1—10月,以六步癌症告知模型、共情沟通模型为理论基础,结合文献分析法、质性访谈和专家论证会构建晚期癌症患者病情告知策略条目。结果文献分析共纳入18篇文献。质性访谈共访谈20名受访者(包括4名医生、11名护士和5例患者),男6名,女14名,年龄(35.94±8.03)岁。专家论证会共有8名专家参与论证,男2名,女6名,年龄(41.88±6.58)岁。最终构建出符合我国临床实践的晚期癌症患者病情告知策略的具体条目及话术,共构建包括沟通前准备、常规沟通策略和沟通不畅的处置策略3条一级条目,16条二级条目,53条三级条目。条目重要性评分4.50~5.00分,条目变异系数为0~0.12。结论基于沟通模型构建的晚期癌症患者病情告知沟通策略具有科学性、可行性,可以作为告知晚期癌症患者病情的工具。Objective To construct a communication strategy and implementation method for advanced cancer patients based on two communication models widely used at home and abroad,so as to reduce the difficulty of clinical disease notification.MethodsFrom January to October 2022,based on the communication model of SPIKES(Setting,Perception,Invitation,Knowledge,Empathy,Summary)and NURSE(Name,Understand,Respect,Support,Explore),combined with literature analysis,qualitative interviews,and expert argumentation,the communication strategy items of advanced cancer patients were constructed.ResultsA total of 18 articles were included in the literature analysis.Qualitative interviews were conducted with 20 interviewees(including 4 doctors,11 nurses,and 5 patients),6 males,14 females,aged(35.94±8.03)years old.A total of 8 experts participated in the demonstration,2 males and 6 females,aged(41.88±6.58)years old.Finally,the specific items and words of the disease notification process and communication strategies of advanced cancer patients in line with China′s clinical practice were constructed.A total of 3 first-level items,16 second-level items,53 third-level items,and speech techniques were constructed,including pre-communication preparation,regular communication strategies,and poor communication disposal strategies.The importance score of the item was 4.50 to 5.00,and the coefficient of variation of the item was 0 to 0.12.ConclusionsThe communication strategy of advanced cancer patients based on the communication model is scientific and feasible,and can be used as a tool to inform advanced cancer patients.

关 键 词：策略 实验性 晚期癌症 安宁疗护 医患沟通 策略构建 

分 类 号：R473.73[医药卫生—护理学]