Older patients attitudes towards and experiences of patient-physician end-of-life communication a secondary analysis of interviews from British, Dutch and Belgian patients 英文参考文献.docVIP

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Older patients attitudes towards and experiences of patient-physician end-of-life communication a secondary analysis of interviews from British, Dutch and Belgian patients 英文参考文献.doc

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Older patients attitudes towards and experiences of patient-physician end-of-life communication a secondary analysis of interviews from British, Dutch and Belgian patients 英文参考文献

Evansetal.BMCPalliativeCare2012,11:24 /1472-684X/11/24 RESEARCH ARTICLE OpenAccess Olderpatients’attitudestowardsandexperiences ofpatient-physicianend-of-lifecommunication: asecondaryanalysisofinterviewsfromBritish, DutchandBelgianpatients NatalieEvans1*,HRoelineWPasman1,SheilaAPayne2,JaneSeymour3,SabinePleschberger4, ReginaldDeschepper5,BregjeDOnwuteaka-Philipsen1andOnbehalfofEuroImpact Abstract Background:Olderpatientsoftenexperiencesub-standardcommunicationinthepalliativephaseofillness.Dueto theimportanceofgoodcommunicationinpatient-centredend-of-lifecare,itisessentialtounderstandthefactors whichinfluenceolderpatients’communicationwithphysicians.Thisstudyexaminesolderpatients’attitudes towards,andexperiencesof,patient-physicianend-of-life(EoL)communicationinthreeEuropeancountries. Methods:AsecondaryanalysisofinterviewsfromBritish,DutchandBelgianpatientsovertheageof60witha progressiveterminalillnesswasconducted.Cross-cuttingthemeswereidentifiedusingathematicapproach. Results:Themesfrom30interviews(Malen=20,Medianage78.5)included:confidenceandtrust;disclosureand awareness;andparticipationindecision-making.Confidenceandtrustwerereinforcedbyphysicians’availability, timeandgenuineattentionandhinderedbymisdiagnosesandpoorcommunicationstyle.Mostparticipants preferredfulldisclosure,thoughsomeremaineddeliberatelyill-informedtoavoiddistress.Patientsexpresseda varietyofpreferencesforandexperiencesofinvolvementinmedicalEoLdecision-makingandafewcomplained thatinformationwasonlyprovidedaboutthephysicianspreferredtreatment. Conclusions:Avarietyofexperiencesandattitudesregardingdisclosureandparticipationindecision-makingwere reportedfromeachcountry,suggestingthatcommunicationpreferencesarehighlyindividual.Itisimportantthat physiciansaresensitivetothisdiversityandavoidstereotyping.Inregardtocommunicationstyle,physiciansare advisedtoprovideclearexplanations,avoidjargon,andcontinuallycheckunderstanding.Boththe‘informed’and the‘shared’patient-physiciandecision-makingmodelsassumep