患者告知家属坏消息的路径、困境及对策  

The path,dilemma,and countermeasures for patients to inform their families of the breaking bad news

作　　者：仲凤行 尹秀平 白天添 ZHONG Fengxing;YIN Xiuping;BAI Tiantian(School of Rehabilitation Medicine,Qilu Medical University,Zibo 255300,China;Medical Experimental Center,China Academy of Chinese Medical Sciences,Beijing 100005,China;School of Education,Beijing City University,Beijing 100191,China)

机构地区：[1]齐鲁医药学院康复医学院,山东淄博255300 [2]中国中医科学院医学实验中心,北京100005 [3]北京城市学院教育学部,北京100191

出　　处：《中国医学伦理学》2025年第1期116-122,共7页Chinese Medical Ethics

摘　　要：在临床工作中,坏消息的告知不可避免,对患者来说,不但要接受、应对坏消息,还要用清晰的思路、恰当的语言将坏消息告知家属,征求家属的支持和配合。分析了坏消息的内涵和告知困境,调研了患者的告知倾向,分析了隐瞒、立即告知、分阶段告知三种告知方式的利弊。在此基础上提出患者告知家属的详细应对策略,包括前期准备、中期阐述和后期总结三个部分,前期要充分铺垫,做好各项准备;中期告知坏消息时强调语言通俗明确,帮助家属调整情绪等;后期总结要确认信息和观点的完整传达。此外,从医生的角度结合医患信任的程度,分析了医生应该扮演的角色和分析步骤。有效的坏消息告知不仅关乎沟通技巧,更涉及对患者及家属心理需求的深刻理解与尊重。通过细致准备、恰当表达、情绪支持及清晰的确认,促进沟通与信任,共同面对并克服困难。Clinically,the occurrence of the breaking bad news is inevitable.For patients,they not only need to accept and cope with bad news,but also need to inform the bad news to their families with clear thinking and appropriate language,seeking their support and cooperation.This paper analysed the connotation and informing dilemma of bad news,investigated patients’informing tendencies,as well as evaluated the advantages and disadvantages of three disclosure methods,including concealment,immediate informing,and staged informing.On these bases,a detailed response strategy for patients to inform their families was proposed in three parts,including pre-preparation,mid-articulation,and post-summary.In the initial phase,thorough preparation is essential.During the middle stage,when delivering bad news,use plain language and help family members adjust their emotions.In the final phase,ensure that all information and viewpoints have been fully communicated.In addition,the roles and analysis steps that doctors should play were analysed from their perspective and combined with the degree of doctor-patient trust.Effective informing of bad news is not only about communication skills,but also involves a deep understanding and respect for the psychological needs of patients and their families.Through meticulous preparation,appropriate expression,emotional support,and clear confirmation,communication and trust are promoted to face and overcome difficulties together.

关 键 词：坏消息告知 医患沟通 告知困境 医学人文 

分 类 号：R-052[医药卫生]