癌症患者的信息需求--病人、亲属、医护人员观点比较

目的：探讨癌症患者、亲属、医护人员对医患之间交流肿瘤信息观点的异同。方法：随机抽取501例癌症患者、169位亲属和86位医护人员，进行IPQCP 2、INQ、DQ测定和分析。结果：在癌症患者、亲属、医护人员之间，患者与亲属或与医护人员之间，关于应否告知癌症患者其诊断、可能的生存时间和病人应否参与制定治疗方案，IPQCP总均分和各维度均分、总的信息内容和信息量选择倾向、交流形式(包括信息来源、告知方式、时间、地点、在场人员及医生态度等)均有显著性差异。结论：在临床上，给予癌症患者信息和医息交流的主要依据是患者本人的意见。     

不同人群对癌症信息交流的认知取向

目的：研究癌症患者、与其相关及其他群体对癌症信息交流的认知取向。方法：随机抽取501例癌症患者、169位亲属、86位医护人员、176位健康老人和505名一年级大学生，进行IPQCP＋2、INQ测定．后两组分别以本人及以患者身份完成2套IPQCP＋2和INQ。结果：各群体之间、患者与各群体之间在应否告知癌症患者其诊断、可能的生存时间和病人应否参与治疗方案制定、IPQCP总均分和各维度均分、总的信启、内容和信息量选择倾向等均有显著性差异。结论：不同群体对癌症信息交流的认知取向明显不同，提示癌症临床医患交流的主要依据是患者本人的意见，癌症预防应根据不同群体的特点、参考患者的看法有针对性地进行。     

癌症患者的信息需求--《癌症患者信息选择问卷》的编制与评估

目的：研制和测评癌症患者信息选择问卷(IPQCP)。方法：以严谨的程序编制问卷，并随机抽取501例癌症患者、169位亲属和86位医护人员进行测定，对问卷作筛选和信度、效度等分析。结果：1．最后问卷共有19个条目，含诊断、治疗、预后、其他四个维度。2．四个维度和总分的重测信度分别为0．85、0．81、0．83、0．76和0．96；Cronbach α分别为0．82、0．89、0．99、0．89和0．95；分半信度为0．95。3．问卷能较好反映癌症患者对信息内容和量的需求，结构与设计的理论构思相符，参照Cassileth信息清单的效标效度为0．9l。结论：IPQCP具有较好的信度和效度，在临床上有一定的实用价值。     

癌症应对问卷的编制与测评

目的:研制和测评癌症应对问卷(CCMQ)。方法:以严谨的程序编制问卷,随机抽取557例癌症患者进行测定,请患者、183位亲属和96位医护人员做适切性评分,并对问卷进行筛选和信效度测评。结果:(1)最后问卷共有26个条目,包括面对、回避与压抑、屈服、幻想、发泄五个维度。(2)问卷具较好的内容效度,能较贴切地反映癌症患者的心理应对情况,结构与设计的理论构思相符,参照MCMQ的效标效度为0.72。(3)五个维度和总分的重测信度分别为0.85、0.80、0.75、0.78、0.76和0.86;Cronbach α系数分别为0.82、0.68、0.78、0.83、0.86和0.88。结论:CCMQ具较好的效度、信度,在临床上有一定的实用价值。     

癌症患者的信息需求—应否与如何告知癌症诊断

目的：研究应否及如何告知患者其癌症诊断。方法：在定性研究基础上以自答问卷调查广州市两所肿瘤医院和省生命之光俱乐部、清楚本人癌症诊断的患者311名。结果：72．99％患者认为“应该告知”其癌症诊断,24．12％认为“因人而异”,2．89％认为“不应告知”。目前给予信息4的某些医患交流与患者的期望有一定距离。大部分患者期望肿瘤科医师在最短时间内、面对面地、在医院内、以关心同情或较好接受的态度告知其或及其家庭癌症诊断。年龄、性别、职业、学历、病期、病程对其观点有一定影响,个性和癌症诊断则无明显影响。结论：肿瘤科医师应以最佳的医患交流方式为患者提供有关癌症诊断的信息。     

癌症患者心理调节问卷的编制与测评

目的:研制癌症患者心理调节问卷(PASCP)。方法:以严谨的程序编制问卷,随机抽取557例癌症患者进行测定,请患者、183位亲属和96位医护人员做重要性评分,并对问卷进行筛选和信度、效度检验。结果:(1)问卷共有36个条目,包括患癌症后对情绪/自尊、主观感受、日常生活、人际关系/社会生活、其他等五个维度和一项总的心理调节自我评价条目。(2)问卷具有较好的内容效度,结构与设计的理论构思相符,5个因子负荷范围和方差分析分别为0.63~0.79和7.44,0.67~0.76和5.42,0.69~0.88和4.77,0.66~0.91和4.77,0.63~0.80和4.38,参照于HAD和FLIC两个问卷的效标效度分别为0.78和0.69。(3)五个维度和总分的重测信度分别为0.83、0.82、0.86、0.78、0.76和0.89,Cronbach α系数分别为0.83、0.86、0.80、0.78、0.69和0.89。结论:PASCP有较好的效度、信度和灵敏度,问卷能较敏感地反映治疗及康复前后患者心理调节的变化。     

急危重症患者家属心理需求情况调查与分析

目的：了解急危重症患者家属心理需求满足程度。方法采用自制问卷调查表对百色市两家三甲医院共136名急诊危重患者家属进行问卷调查。结果94.12%的家属对患者病情不了解；93.38%家属对治疗方案不满意；而仅7.35%家属从医生方面了解患者病情。结论急诊医护人员在抢救患者的同时应重视家属这一群体的心理需求的满足，以维护其身心健康，帮助其度过心理难关，从而有利于医患纠纷的防范。     

癌症与精神病人亲属心身状况及改善对策的跨文化探讨

目的研究居澳华裔及国内癌症及精神病人亲属的健康状况。方法以深层面谈和电话会谈、问卷法调查居澳华裔、居国内的癌症和精神病患者及其亲属共288人。结果绝大部分亲属有不同程度的焦虑、抑郁，伴有失眠、疲劳、衰弱等症状。2.78％～11．11‰被诊断为焦虑症、抑郁症或各种心身疾病。癌症病人亲属的健康状况随病人病情的波动而变化；精神病人亲属的健康状况随病人病情的进展和时间的推移趋向稳定。国内组与澳洲组表现有一定的差别。他们希望有完善的机构与设施帮助照顾其患病的亲人。结论建立完善的机构为癌症及精神病患者提供照顾等服务，帮助其亲属进行有效的心理调节，保持心身健康，是21世纪的国际性课题之一。     

医护人员工作满意度与组织承诺关系研究

目的了解医护人员工作满意度和组织承诺现状并探讨两者之间关系。方法采用工作满意度量表和组织承诺量表对150名山东省潍坊市3所医院医护人员进行调查。结果医护人员的总体工作满意度和组织承诺均处于中等略偏上水平；相关分析表明，工作满意度总体及各维度与组织承诺均显著正相关；回归分析表明，工作关系、晋升、单位经营管理满意度对组织承诺具有显著的正向预测作用，同时发现工作环境满意度对价值承诺：年口努力承诺具有负向预测作用。结论医护人员工作满意度与组织承诺具有显著相关。     

对200例糖尿病、高血压出院患者进行随访沟通的效果初探

目的 通过随访了解患者出院后的需求,及时给以指导和帮助,提高患者对医疗的依从性和满意度.方法 对200例出院患者在1年内进行四次随访,时间分别为:出院后2周、2个月、半年、1年,对出院患者提出的意见或建议及时整改,并对患者的需求及时指导和帮助.结果 四次随访沟通的效果渐次向好,患者的遵医行为及满意度逐次提高.结论 随访有助于提高患者对医疗的依从性和满意度,促进医患关系和谐发展.     

Telling the truth about cancer: views of elderly patients and their relatives

The aim of this study was to compare the attitudes of elderly patients and their relatives towards telling the truth about cancer. 120 patients were asked if they would wish to be told about bad news, such as cancer, which might emerge during the admission. Matched relatives were asked if such information should be disclosed to the patient. Of the 120 patients, 99 (83%) wanted to be told the truth; 66 relatives (55%) relatives wanted their next of kin informed. There was agreement in 73 (61%) pairs. The kappa statistic was 0.16 (95% confidence interval -0.03 to 0.35), which indicates poor agreement. We conclude that most elderly people wish to be informed of a diagnosis of cancer. Patient preferences cannot be predicted by talking to relatives.     

Genetic services for men: the preferences of men with a family history of prostate cancer.

PURPOSE: Men have a lower uptake of genetic services than women; however, the specific needs and preferences of men at risk of genetic conditions other than hereditary breast ovarian cancer are not known. We ascertain the information preferences of men with a family history of prostate cancer. METHODS: Unaffected men and their partners were administered a written questionnaire. RESULTS: Responses were received from 280 men (response rate: 59.2%) and 174 partners (response rate: 74%). Most men (59.6%) reported having insufficient information about their risk and wanted further information about personal risk (93.2%) and risk management (93.6%). Strikingly, 56.3% preferred to receive information related only to positive outcomes. Urologists were the preferred source of information, but there was considerable interest in a multidisciplinary service approach significantly associated with the number of affected relatives (odds ratio = 1.94, P < .002). Partners' level of concern was not associated with interest in multidisciplinary services, satisfaction with information, or support received. CONCLUSIONS: Delivering services to men at risk will require a multifaceted approach by primary care providers and specialists. Challenges include meeting men's expectations in the face of uncertain medical knowledge, engaging those at high risk in multidisciplinary services, and delivering tailored information to those at lower risk.     

Information and decision making: patients' needs and experiences in the course of breast cancer treatment

OBJECTIVE: This study explored breast cancer patients' preferences and experiences in receiving information and decision making in the course of the first 6 months of cancer treatment. METHODS: Participants were 135 German breast cancer patients, recruited within a week of either surgery or the beginning of neo-adjuvant chemotherapy. Women were asked to complete a self-explanatory questionnaire at baseline and 3 and 6 months later. RESULTS: There was a significant decrease in the importance of specific information needs. The quality of received information through the physician was rated significantly better at baseline than 6 months later. Nearly half of all patients changed their decision making preference at least at one assessment point. Shared decision making rarely took place in the first 6 months of treatment. CONCLUSION: Breast cancer patients' information needs and decision making preferences can change during treatment. Future research should analyse which patients change their decision making preference under which circumstances. PRACTICE IMPLICATIONS: Physicians need to investigate the decision making preferences and information needs of their patients in the course of treatment. Patient oriented communication skills might be helpful to meet patients' preferences and needs.     

Tailoring the amount of treatment information to cancer patients’ and survivors’ preferences: Effects on patient-reported outcomes

ObjectivesTailoring medical information to cancer patients’ needs is recommended, but there is little guidance on how to tailor, and limited research exists about its effects. Tailoring to the amount of preferred information may be easily implementable in clinic and is tested here.MethodsA video-vignette experiment was used to systematically vary video patients’ information preferences (limited/extensive) and amount of provided information (additional/no additional). N = 253 cancer patients/survivors evaluated these video-recorded consultations, serving as analogue patients (APs), and completed outcome measures.ResultsTailoring information to video patients’ preferences had no effect on APs’ evaluation of the consultation (satisfaction, trust). Yet, there was a main effect of APs’ own information preferences: Those preferring extensive information recalled (MΔ = 5.8%) and recognized (MΔ = 3.5%) more information than those preferring limited information. Moreover, information provision mattered among APs who preferred limited information: They recognized even less if provided with extensive information.ConclusionsTailoring to the amount of video patient’s information preferences did not affect APs’ evaluation of the consultation (satisfaction, trust), while APs’ personal information preferences determined their recall and recognition of medical information.Practice implicationsInformation preferences should be assessed and tailored to in clinical practice. Overwhelming patients/survivors, who prefer limited information, should be prevented.     

Are otolaryngologists specialist for pollinosis?]

It is approved that ENT doctors are specialist for pollinosis. Is it true from the point of view of patients' medical care-seeking behavior? 214 patients with Japanese cedar pollinosis who had visited medical doctors in 2003 pollen-season were randomly sampled from 603 pollinosis patients registered at a disease survey company and we mailed self-evaluation questionnaire on patients' medical care-seeking behavior on the end of pollen season in 2004. Response rate was 65.3%. Patients visited clinics in approximately 90% more than hospitals. They selected ENT in 43.9% and general physicians in 31.1%. Their selections were based on others than their specialty such as easy access and previous experience of visit, because pollinosis is not serious disease like cancer. ENT doctors treated the patients by combination of two kinds of tablet or topical steroid with tablet, while general physicians did with single kind of tablet. The patient satisfaction, and its related questions including preference, wish to revisit in next year and recommendation to their friend were not different in treatment between ENT and general physician. Doctors' attitude, and communication with patients were the most important factor for patient satisfaction as well as treatment out-come. In conclusion, patients prefer agreeable and convenient treatment. If ENT doctors still want to be specialist for pollinosis, they should take care patients well and develop their own specific treatment methodology to cure this disease.     

The development of a scale to discover outpatients' perceptions of the relative desirability of different elements of doctors' communication behaviours

OBJECTIVE: The objective of the study was to discover which aspects of doctor communication behaviours are more or less desirable to patients who are attending medical outpatients clinics. METHODS: Two hundred and twenty patients took part in the study, which was undertaken in four phases. In phase one, patients completed a 10-item questionnaire where they indicated, by means of a five-point scale, their preferences for doctor communication behaviours. In phases two and three patients qualitatively expressed the meaning that they ascribed to terminology that is used by some researchers to define doctor communication behaviours. In the final phase of the study a 12-item questionnaire was developed by integrating the phase one questionnaire and patients' report from phases two and three. Patients indicated, by means of a five-point scale, their preferences for different communication behaviours that might be used by doctors. Patient's preferences were ranked in terms of the most to the least preferred behaviours. RESULTS: The findings suggest that patients most prefer consultations where doctors give information spontaneously and display affective behaviours. They least preferred consultations where medical matters are discussed and where information is not forthcoming. Furthermore, the finding suggests that the use of blanket terms by researches in defining doctor communication can lead to differences in interpretation by patients. CONCLUSIONS: The methods developed in the study appear to provide a useful tool to discover patients' desires in terms of doctor communication. PRACTICE IMPLICATIONS: The rank scale developed in the study could prove useful to medical practice. It could, for example, provide a straightforward method whereby doctors could readily access researcher's recommendations about communication. Furthermore, the scale could be used in various healthcare settings in order to discover if different patient groups vary in terms of the doctor communication they desire.     

Screening adherence and cancer risk perceptions in colorectal cancer survivors with Lynch‐like syndrome

Cancer screening recommendations for patients with Lynch‐like syndrome (LLS) are not well defined. We evaluated adherence to Lynch syndrome (LS) screening recommendations, cancer risk perceptions, and communication within the families among colorectal cancer (CRC) survivors with LLS. Thirty‐four participants with LLS completed a questionnaire about risk perception, adherence to LS screening recommendations, and communication with relatives. Clinical data were obtained from medical records. Most participants (76%) believed they should undergo colonoscopy every 1–2 years. Only 41% correctly interpreted their genetic tests as uninformative negative or as variant of unknown significance for LS. Less than half had had an upper gastrointestinal endoscopy for screening purpose. Among female participants, 86% had been screened for endometrial cancer (EC) and 71% for ovarian cancer. Most participants had informed relatives about the CRC diagnosis and advised them to undergo CRC screening, but only 50% advised female relatives to be screened for EC and only one‐third advised relatives to have genetic counseling. Most CRC survivors with LLS follow the same cancer screening recommended for LS patients but do not understand the meaning of LLS. Greater care must be devoted to communicating the implications of nondiagnostic germline mutation testing among patients with LLS.     

Perceived genetic knowledge, attitudes towards genetic testing, and the relationship between these among patients with a chronic disease

OBJECTIVE: Genetics increasingly permeate everyday medicine. When patients want to make informed decisions about genetic testing, they require genetic knowledge. This study examined the genetic knowledge and attitudes of patients with chronic diseases, and the relationship between both. In addition, patients were asked about their preferred source of genetic information. METHODS: Questionnaires were mailed to participants of a nationwide representative sample of patients with chronic diseases in the Netherlands (n = 1916). RESULTS: The response rate was 82% (n = 1496). Perceived genetic knowledge was low, particularly among older and lower educated patients. Attitudes towards genetics were rather positive, especially among younger and higher educated patients. Some concerns were also documented, mainly about the consequences of genetic testing for employment and taking insurance. Patients who perceived to have little knowledge found it difficult to formulate an opinion about genetic testing. Higher levels of genetic knowledge were associated with a more favourable attitude towards genetics. Chronic patients prefer to receive genetic information from their GP. CONCLUSION: Chronic patients are ill prepared when they require genetic knowledge to make decisions regarding the treatment of their disease. This seems to result from a knowledge deficiency rather than from disagreement with the genetic developments. PRACTICE IMPLICATIONS: When chronic patients are in need of information about genetics or genetic testing, their general practitioner should provide this.     

军队医务人员生活事件、焦虑水平及与工作满意度的关系

目的:了解军队医务人员群体的应激现状和主要来源及其与工作满意度的关系。方法:对驻某地区的3家军队中心医院的300名医务人员(现役军人)进行调查,采用生活事件量表、军人心理应激自评问卷等为测量工具。结果:军队医务人员应激的主要来源为工作学习事件,焦虑水平和生活事件对工作满意度有显著的预测力。结论:减少军队医务人员生活事件,降低其焦虑水平,能有效提高其工作满意度。