告知患者癌症诊断的利弊分析及有效告知的方法

告知患者癌症诊断是肿瘤科的核心问题。法律和医学伦理原则要求医务人员应掌握肿瘤患者的心理和其他方面的特殊性,及时、充分地与患者及家属进行沟通,严格履行肿瘤患者的知情同意原则。本文旨在对告知患者癌症诊断的利弊及有效告知癌症诊断的方法进行分析,以期为临床肿瘤医疗、护理工作提供指导。     

癌症患者家属决策癌症诊断告知状况的初步调查

癌症的致命性以及文化背景的不同使人类对癌症有着特殊的认识。在东方国家,家属在癌症诊断告知的过程中起着决策性的作用。本研究对194例癌症患者家属进行调查,探讨家属对告知患者癌症诊断的认识以及医生、患者等的观点和行为对家属决策过程的影响,初步揭示国内癌症诊断告知的实施状况及所存在的问题,为临床医护人员有效告知癌症诊断提供依据。     

告知癌症患者真实诊断信息的策略

癌症死亡率高的特点,使人们“谈癌色变”.由于考虑到癌症患者得知诊断结果后产生不良影响,现在我国大多数临床医生还在采用隐瞒的告知方式.笔者通过对不告知癌症患者真实诊断的利弊分析以及告知真实诊断的理由论述,提出解决的策略,旨在帮助临床医生解决临床告知中的难题.     

晚期癌症患者家属的病情告知态度探究

本文采用自行设计的调查问卷,对200例晚期癌症患者家属进行问卷调查,以探讨晚期癌症患者家属对病情告知的态度。结果显示,认为病情应绝对保密者55例（27．5％）;暂时保密者107例（53．5%）;而不保密者38例（19．0％）。晚期癌症患者家属普遍采取“慈悲原则”,对患者病情持保密态度;癌症患者家属普遍缺乏病情告知策略。临床医生在执行知情同意时应该依据患者不同的家庭情况,有针对性地进行告知。     

癌症保密和告知与医生的行为浅议

癌症保密和告知与医生的行为浅议第三军医大学博士生（重庆６３００３３）杨和平导师毛宝龄沈寒放在当前的临床医疗实践中,面对越来越多的癌症患者是采取保密性医疗还是告知性医疗,是从事肿瘤患者心身障碍研究的临床医学家和医学伦理学家们所关注的重要议题。主张保密性...     

医护人员对癌症告知态度的调查研究

为了了解医护人员对癌症告知的态度,对634名医护人员进行问卷调查.结果显示,医护人员不十分赞同将真情完全告知患者,其告知意愿在一定程度上取决于患者的知情愿望,他们比较认同家属拥有决策权,且普遍认为患者不是充分知晓病情.因此,医护人员应该增强告知认识,尊重患者告知意愿,引导家属告知观念,努力提高患者知情程度.     

癌症坏消息告知喜好研究进展

坏消息指的是对被告知者期望的目前或将来的情况进行否定的消息,癌症坏消息告知是医疗实践和医患沟通过程中不可缺少的部分。本文拟通过梳理癌症坏消息告知喜好研究进展,对已有的两种癌症告知沟通技巧训练模式美国SPIKES Model和日本SHARE Model进行比较,提出我国应进一步拓展癌症告知喜好研究、探索本土的癌症病情告知技巧训练沟通模式及推动医患共同决策等建议,以期为医护人员临床实践提供理论指导,为促进稳定和谐医疗大环境形成尽微薄之力。     

妇癌患者术前告知的思考

外科手术是癌症治疗的重要手段,术前谈话告知是外科手术不可缺失的必要步骤,也是保障围手术期安全的关键步骤之一.新的医疗环境对术前谈话提出新的挑战,本文就患者、家属和医者三方面进行反思,探讨新形势下术前告知的深层次问题和解题方法.     

癌症病情告知的家庭主义模式

癌症病情告知涉及到的是一个不同于癌症患者知情同意权的问题。中国癌症病情的告知具有不同于西方的特点,形成了一种不同于西方的家庭主义模式。家庭主义模式的确立,可以从患者的脆弱性和文化传统的影响两个方面进行辩护。在新的时代背景下,癌症病情告知的家庭主义模式面临个体权利意识觉醒和家庭社会结构变迁带来的挑战。有必要确立一种程序性的家庭主义模式,在尊重癌症患者知情权的基础上,按照家庭主义模式设计患者行使知情权的具体程序,在保障患者知情权和发挥家庭照护作用之间求得平衡。     

癌症患者家属选择是否告知患者真实病情的质性研究

在东方或发展中国家,家庭成员得了癌症后,家属通常反对告知患者真实病情。本研究运用质性研究方法对15例癌症患者家属进行深入访谈,探讨癌症患者家属选择是否告知患者真实病情的原因,以其为临床医护人员正确处理癌症病情告知问题提供指导。     

Telling stories

Patients need to tell their stories. One of our primary tasks as analysts is to help patients tell their stories and own them. The freedom of mind to think, to feel, and to know are dependent on the ongoing capacity for storytelling. The analyst's stance plays a major role in the development of the analysand's storytelling capacities.     

Telling lies

Men and women (20 each) were videotaped while describing someone they liked, someone they disliked, someone they were ambivalent about, someone they were indifferent about, someone they liked as though they disliked him or her, and someone they disliked as thought they like him or her. Accuracy at detecting that some deception had occurred was far greater than accuracy at detecting the true underlying affect, and people who were good at detecting that deception was occurring were not particularly skilled at reading the speakers' underlying affects. However, people whose deception attempts were more easily detected by others also had their underlying affects read more easily. Speakers whose lies were seen more readily by men also had their lies seen more readily by women, and observers better able to see the underlying affects of women were better able to see the underlying affects of men. Skill at lying successfully was unrelated to skill at catching others in their lies. A histrionic strategy (hamming) was very effective in deceiving others, and this strategy was employed more by more Machiavellian people, who also tended to get caught less often in their lies. Methodological considerations and systematic programs for future research are discussed.     

看相算命

“风水“真能带来好运吗? 　　风水一说,最早见于晋代郭璞&;lt;葬书&;gt;,旧称“堪舆“.风水“理论“认为,住宅(阳宅)、墓地(阴宅)周围的风向、水流、地势等,关系到住者或葬者一家的祸福.在风水先生看来,造屋、墓葬都要与宇宙之气相协调,聚“吉气“而忌“煞气“、“死气“,否则便不能吉祥平安.其实,生老病死乃自然法则,富贵贫贱依人事而论,与住宅、坟地的地形、地貌、方向、气候并不相干.……     

Telling the Truth About Power

SUMMARY

In this culture, those in power do not usually talk about it and the rest of us tend not to recognize it either. A similar situation exists in therapy, where the therapist herself may not be aware of her own power-over tactics. This article suggests methods that may help therapists to acknowledge their power and also to change from power-over actions to mutually empowering relationships. From this line of thinking, there follows an exploration of altering the concept of boundaries in therapy into mutually constructed agreements between patient and therapist. This article was presented at the Summer Training Institute of the Jean Baker Miller Training Institute, June, 2003.