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--医患交流满意度及影响因素分析

目的：探讨癌症患者、亲属、医护人员对医患信息交流的满意度及其影响因素。方法：随机抽取广州市两所肿瘤医院、部分综合医院和省生命之光俱乐部、清楚本人癌症诊断的患者423例，采用自评信息需求问卷(INQ)、一般情况问卷(DQ)进行测查，并了解患者及其已获得需要的信息内容和数量、对医患交流的满意度。请82位亲属和86位医护人员回答了对医患交流的满意度，对结果进行分析。结果：癌症患者、亲属、医护人员均有一定比例对医患信息交流的满意度不高，三者有显著性差异，医护人员满意度较低，提示其希望提高医患交流水平。患者的满意度受信息交流内容、交流形式、患者经历及信息与其偏好或建议符合程度的影响。结论：在进行医患信息交流之前了解患者的需求和建议，提供患者需要的信息，并以其乐于接受的形式进行交流，是提高医患信息交流水平和满意度的关键。     

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。     

癌症患者的信息需求--信息选择情况及影响因素分析

目的 :分析癌症患者的信息选择情况及影响因素。方法 :请广州市两所肿瘤医院、部分综合医院和省生命之光俱乐部、清楚本人癌症诊断的患者 5 0 1例自评癌症患者信息选择问卷 (IPQCP)及 2个了解总信息量和内容需求倾向的问题 ( +2 )和一般情况问卷 (DQ) ,其中 3 86名加填艾森克人格问卷 (EPQ) ,并对测查结果进行分析。结果 :5 0 1例患者IPQCP的总分、D、T、P、O维度均分分别为 48 0 9± 8 78、 2 5 6±0 48、 2 45± 0 5 0、 2 47± 0 5 2、 2 3 0± 0 5 2。 5 6 49%的患者希望知道“一切 ,无论好坏”的信息内容 ,77 2 5 %希望获知“越多越好”的信息量。希望知道“治愈的可能性有多大”比例最大 ,而对“可能的生存时间”意见不一。较年轻、某些年龄组女性、学历较高及脑力工作者IPQCP某些分值较高 ,希望获知的信息内容和量较多 ;癌症预后较差、EPQ中N和P分较高者需求的信息内容和量较少。结论 :医生在为癌症患者提供信息时 ,应注意其不同特点和个体差异 ,更好地满足其信息需求。     

癌症高危因素及先兆表现清单的编制

目的:编制癌症高危因素及先兆表现清单并测定其信效度.方法:根据癌症发生最常见的高危因素及先兆表现建构理论维度,参考前期研究、C型行为特征及量表编写条目,随机抽取693例癌症患者进行测定,请患者、129位亲属和103位医护人员做条目重要性评分,并请706位人口统计学资料与患者类似的健康人填写清单.结果:①经过项目分析和探索性因素分析,最后保留19个条目,归纳为躯体、心理、社会因素、生活习惯4个因子(维度).②清单具较好的结构效度,4因子累计解释方差变异的77.92%;比较患者与健康人群的四个维度均分和总均分有显著性差异.③四个维度均分和总均分的重测信度分别为0.82、0.76、0.80、0.77和0.83;Cronbach α分别为0.76、0.79、0.83、0.80和0.86;分半信度为0.90.结论:症高危因素及先兆表现清单具较好的效度和信度,在临床上有一定的实用价值.     

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。     

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。     

精神科医护人员心理健康状况及有关因素调查

用症状自评量表（ＳＣＬ－９０）对山东８个地市级精神病医院的医护人员６８４名进行了心理健康状况调查。结果显示：精神科医护人员总的心理健康状况较好，ＳＣＬ－９０总均分及各因子分均较一般人群偏低，逐步回归揭示，影响医护人员心理健康水平的前三位因素依次为：来自患者的心理损害、自身健康状况和生活事件。     

双相情感性障碍患者及其一级亲属EPQ测试的初步分析

本文对符合ＣＣＭＤ－Ｄ－２中情感性障碍诊断标准的患者１００例，及其一级亲属１８９人进行艾森克个性问卷调查。结果发现：患者及其一级亲属的Ｐ、Ｅ、Ｎ量表分都显著高于常模均值，而患者与亲属之间却无显著性差异。情感性障碍患者及其一级亲属的个性特征具有精神病质、个性外向、情绪不稳定的倾向。本文就患者及其一级亲属的个性特征和有关问题作了初步分析。     

Meeting information needs of significant others: use of the Cancer Information Service

Although significant others (spouses, relatives and friends) of cancer patients play an important role in providing support and assistance to the patient, their need for information regarding the disease is frequently overlooked by the health care system. This analysis examines information needs of (1) diagnosed cancer patients, (2) significant others of diagnosed cancer patients and (3) the general public, as reflected in their calls to the Cancer Information Service (CIS), a national toll-free telephone inquiry service. Major focus is on the types of cancer-related subjects significant others inquire about, as well as how they first found out about the CIS. Results indicate that significant others are similar to diagnosed cancer patients in their need for additional information on specific cancer sites, treatment, and referrals for second opinions, but differ in their request for information on counseling services and clinical trials. Additionally, significant others and cancer patients are similar in how they find out about the CIS. In contrast, significant others differ from the general public in their information requirements, as well as in their source of referral to the CIS. While the CIS appears to be a channel of communication capable of addressing the dynamic information needs of significant others, further research concerning the effectiveness of the CIS and other channels of cancer information in satisfying the information requirements of significant others is recommended.     

Breaking Bad News in Cancer Patients

Objective:

In a regional hospital, many patients are newly diagnosed with cancer. Breaking the bad news in these patients and their relatives is a tough task. Many doctors are not experienced in talking to patients about death or death-related diseases. In recent years, there have been great efforts to change the current situation. The aim of this study was to investigate the experience and education of medical personnel in breaking bad news in a secondary hospital.

Materials and Methods:

59 doctors from General Hospital of Komotini, Greece were included in the study. All the doctors were in clinical specialties that treated cancer patients. A brief questionnaire was developed based on current guidelines such as Baile/SPIKES framework and the ABCDE mnemonic.

Results:

Residents are involved in delivering bad news less frequently than specialists. Only 21 doctors (35.59%) had specific training on breaking bad news. 20 doctors (33.90%) were aware of the available techniques and protocols on breaking bad news. 47 doctors (79.66%) had a consistent plan for breaking bad news. 57 (96.61%) delivered bad news in a quiet place, 53 (89.83%) ensured no interruptions and enough time, 53 (89.83%) used simple words and 54 (91.53%) checked for understanding and did not rush through the news. 46 doctors (77.97%) allowed relatives to determine patient''s knowledge about the disease.

Conclusions:

There were low rates of specific training in breaking bad news. However, the selected location, the physician''s speech and their plan were according to current guidelines.     

Palliative care at home: an audit of cancer deaths in Grampian region.

BACKGROUND: Ninety per cent of the last year of life of cancer patients is spent at home. Some studies have suggested that care in this setting is often suboptimal. Information on the standard of palliative care delivered at home by general practitioners (GPs) and their teams is limited, and clarification of the problems faced is needed. AIM: To audit the home-based palliative care of patients dying of cancer. METHOD: Matched postal questionnaires were sent to the GPs and nurses of 1086 successive patients dying of cancer in whatever setting in the Grampian region of Scotland some six weeks after the death to establish the professionals' perception of symptom control, communication problems, use of services, and information given to patients and relatives. RESULTS: Response rates were 88.8% for GPs (964 out of 1086) and 87.1% for nurses (325 out of 375 that were passed on to nurses). Two-thirds of patients received palliative care at home. Pain was poorly controlled in 15.7%, and poor control of other symptoms ranged from 13.8% (nausea and vomiting) to 21% (depression and dyspnoea). Communication difficulties were present in 93.7% of cases, although only 5.2% of these were of a major nature. District nurses were involved in 76.7% of cases and Macmillan nurses in 28.0%. Twenty-six per cent of referrals to district nurses were assessed as being late in the course of the illness. Patients were fully informed about the diagnosis in 66.3% of cases and about the prognosis in 55.4%. General practitioners were more likely to report the presence of communication problems between themselves and the patient (when compared with nurses: 43.9% versus 28.0%), more likely to report that patients were 'not at all informed' about self-help groups (57.5% versus 36.3%), and were less likely to report the involvement of occupational therapists (21.8% versus 39.7%). CONCLUSIONS: Levels of reporting of poor symptom control by professionals was much lower than levels reported by relatives in other studies, but there was no difference between the reporting of GPs and nurses. However, a number of areas were identified where care could be enhanced by improved teamwork and further education and training in symptom control, as well as in communication, use of services, and information provision.     

What stroke patients want to know and what medical professionals think they should know about stroke: Korean perspectives

BACKGROUND AND PURPOSE: Patients and medical professionals are likely to have different perspectives of stroke, making what patients want to know about stroke different from what medical professionals think they should know. We wished to determine these differences for patients and medical professionals in South Korea, as well as to identify patients' characteristics associated with perceptions of stroke education. METHODS: Fifty consecutive patients with acute stroke admitted to Asan Medical Center, Seoul, Korea, and 88 medical professionals (31 doctors and 57 nurses) working in the Departments of Neurology or Neurosurgery were administered a structured questionnaire regarding various aspects of patient education concerning stroke. RESULTS: The average ranking of total items for stroke education was higher in nurses than in doctors or patients (P < 0.01 for each). Patients gave higher rankings than doctors for 'possibility to cure with drug treatment' (P < 0.01), 'stress management' (P < 0.01), and most items concerning 'general medical knowledge' and 'post-stroke diet management,' whereas doctors gave higher rankings than patients for most items concerning risk factor management and treatment with surgery. Items concerning 'post-stroke diet management' were ranked lower by male patients than females patients (P < 0.005), and were ranked lower by doctors than by patients or nurses (P < 0.001). Younger patients gave higher rankings than older patients for items concerning 'medical knowledge regarding stroke,' 'exercise,' and 'post-stroke sexual activities' (P < 0.001 for each). CONCLUSIONS: Perspectives on stroke education differ among doctors, nurses and patients. They also differ according to the situation of the patient. Education of stroke patients should be based on an understanding of these differences.     

Doctors, Patients, and Perceived Job Image: An Empirical Study of Stress and Nurses in Singapore

This study examined the relationships among three potential sources of stress, namely, demands from patients/relatives, demands from doctors, and perceived job image, and several work-related outcomes, namely, job satisfaction, organizational commitment, intention to quit, and job-induced tension. Respondents consist of nurses from two tertiary-care hospitals in Singapore. Findings of this study suggest that demands from patients/relatives, doctors, and perceived job image were significantly associated with nurses' job satisfaction, organizational commitment and job-induced tension. While demands from patients/relatives and perceived job image were significantly associated with intention to quit, the relationship between demands from doctors and nurses' intention to quit failed to reach statistical significance. Implications of the findings are discussed.     

Knowledge and perceptions of a domiciliary hospice service among general practitioners and community nurses.

Within a single district health authority all the general practitioners and community registered general nurses were asked to complete a questionnaire regarding awareness and perceptions of a domiciliary hospice service. Responses were received from 127 doctors (71%) and 58 nurses (80%). Awareness of resources offered by the domiciliary hospice service was high, especially among the 102 respondents with access to the service. Eighty per cent or more of general practitioners and community nurses were satisfied with the amount of information received concerning changes in the patient's condition and who was involved in the care process. However, 33% of nurses agreed that it was difficult to know who had overall responsibility for the patient's care and 28% of nurses felt that their own contribution was under-rated. These findings were reinforced by a number of written statements submitted by the nurses. There was a desire expressed by both general practitioners and community nurses for more educational input from the domiciliary service. Overall, assistance from the service was welcomed and its special skills acknowledged. In the future planning of a comprehensive hospice service the differing needs expressed by doctors and nurses should be taken into account.     

Attitudes of physicians, nurses and relatives towards end-of-life decisions concerning nursing home patients with dementia

OBJECTIVE: For many nursing home patients in the advanced stages of dementia, a decision to start or forgo treatment has to be taken at the end of their life. It is very important for the peace of mind of all involved in such decision-making that there is agreement on which decision is in the best interest of the patient. It is thus important to investigate the attitude of physicians, nurses and relatives towards medical end-of-life decisions concerning patients with dementia, so that the policy in nursing homes can be tuned to stimulate dialogue and understanding between all parties. METHODS: Fifteen statements about artificial nutrition and hydration (ANH), advance directives, hastening death, self-determination and euthanasia, and nursing home policy were presented to physicians, nurses and relatives of nursing home patients suffering from dementia. RESULTS: In general, physicians, nurses and relatives agree on many aspects of end-of-life decision-making for nursing home patients with dementia. However, on some issues the outcomes of the decision-making may differ. Relatives attach more importance to advance directives than physicians, and have more permissive attitudes towards hastening death. CONCLUSION: Although physicians, nurses and relatives are all guided by the best interest of the patient, it seems that differences in religious beliefs, perspective of the patient, and responsibility can lead to different attitudes towards end-of-life decisions. PRACTICE IMPLICATIONS: Physicians should discuss end-of-life decisions more openly. Physicians should be aware of the influences on attitudes and incorporate them into communication about end-of-life decisions.     

医生、护士、患者评价优秀临床护士的差异性研究

从优秀临床护士的评价入手 ,通过护士的合作者 :医生 ,护理工作服务对象 :患者及护士自身对优秀临床护士进行评价 ,明确临床护理工作对护士的要求 ,从而确定优秀的临床护士所应当具有的特质 ,并为优秀临床护士评价提供实证性的建议。1　对象与方法1.1　被试取样本研究选取新疆地区不同医院 ,不同科室的医生、护士、患者作为被试。被试来自 :新疆维吾尔自治区人民医院 ,友谊医院 ,新疆维吾尔自治区昌吉州医院 ,新疆石河子大学医学院附属第一临床学院 ,石河子市人民医院 ,石河子市纺织医院 ,石河子市通联医院。发放问卷 2 0 0 0份 ,回收有效问…