生物谷报道：在治疗过程中，医生对待病人的态度对疗效有很大影响，有时甚至会超过医学治疗效果。但是，美国杜克大学研究人员却发现，肿瘤医生和患者之间基本上没有情感的交流，这一研究结果发表在最新出版的《临床肿瘤学杂志》（Journal of Clinical Oncology）上。
良言一句三冬暖。詹姆士·塔斯克博士是杜克大学安宁关怀中心主任，他认为：“肿瘤医生的作用是绝对的。”研究人员也支持这样的观点，即一位肿瘤专家几句温暖体贴的话对癌症患者了解病情、配合治疗有很大的帮助。
《纽约时报》讲述了一个真实的故事。4年前，丹尼斯同时被查出患上两种癌症。在一年多的时间里，她需要进行一次大手术和几次小手术，并同时接受化学治疗和放射性治疗。在这段时间里，她的体重减少了30磅，化疗导致她的头发脱落、指甲破裂、眼睛干燥、嘴唇疼痛，夜不能寐，她变得瘦骨嶙峋、弱不禁风。放射性治疗灼伤了她的皮肤，她在出门时不得不在脖子上系一条丝带。
丹尼斯必须经常去看她的两位医生。放射性治疗的医生会用自己的手臂搂着她虚弱的肩膀，带她到走廊上，两人仿佛是老朋友。而肿瘤医生则会密切注视治疗的副作用，提醒她治疗已有了好的效果，头发会重新长出来。
丹尼斯无限感激这两位女医生给她的温暖和鼓励，她完全相信她们和她们提出的建议。现在，已经康复的丹尼斯说，医生们的同情心在帮助她渡过难关、战胜疾病的过程中发挥了巨大作用。
为了研究患者和医生间的情绪交流问题，塔斯克和同事记录了51位肿瘤学家和270位晚期癌症患者之间的398次对话，并仔细倾听了患者向医生述说情感的片段，以及医生的回应。如果医生回答：“我能想象这对你来说是多么可怕的事。”那么这样的回应是具有同情心的，并允许患者继续表达自己的情感。但是，如果医生回答：“给我们时间，我们正在处理你的问题。”那么这实际上是阻止患者继续表达感情的信号。
研究人员发现，只有22%的医生以同情的方式回应患者的忧虑，而且男性医生比女性医生表现得更糟：48%的男性医生从不鼓励患者表达情绪，而这样做的女医生只有20%。更令人吃惊的是，只有37%的患者会向医生表达情绪。塔斯克说：“这相当不正常，因为他们都是晚期癌症患者。”
目前还不清楚患者为什么有这样的表现，但塔斯克认为，患者可能根本就不期望从医生那里得到同情。当患者和医生都是女性时，这种交流才最有可能发生，年轻的医生也更具同情心。
塔斯克说，一位具有同情心的医生在看到一位新患者时会说：“告诉我你对自己的病有多少了解。”当患者流泪时，这位医生会停下来，直至他们之间能继续交流。相反，当患者说“我害怕”时，有的医生则会用“科学借口”来阻止这种情绪的交流：“这种情况我们看得多了。”
塔斯克认为，医生们不是缺乏同情心，而是困于表达。这篇研究论文的第一作者Kathryn I. Pollak是杜克大学的社会心理学家，她说：“肿瘤医生深切地关心他们的病人，一听录音磁带就明白了。”癌症患者和肿瘤医生间有一种特殊的密切关系，因为患者是在为生存斗争。
即使如此，肿瘤医生也会忽略一些悲痛的信号，特别是那些间接表达的信号。比如，患者可能想知道肿瘤有多大了，医生回答说：“只有几毫米。”但患者真正想知道的是：肿瘤究竟是变大还是变小了，我会死吗？
塔斯克说，好消息是绝大多数医生都受到了这样的教育：以更友善的方式回应患者。简而言之，只要有同情心就足够了。研究人员并不建议过于宽泛的意见咨询或医生与患者间无休无止的对话。
患者向医生表达害怕和痛苦的心情，并寻找医生的同情和帮助，这是合理的要求。“当你说出自己的情感时，实际上会让自己更容易受到伤害。”Pollak说：“但我仍然建议患者尽可能直接向医生倾述。”
生物谷推荐原始出处：
Journal of Clinical Oncology, Vol 25, No 36 (December 20), 2007: pp. 5748-5752
Oncologist Communication About Emotion During Visits With Patients With Advanced Cancer
Kathryn I. Pollak, Robert M. Arnold, Amy S. Jeffreys, Stewart C. Alexander, Maren K. Olsen, Amy P. Abernethy, Celette Sugg Skinner, Keri L. Rodriguez, James A. Tulsky
From the Duke Comprehensive Cancer Center, Cancer Prevention, Detection, and Control Research Program; the Department of Community and Family Medicine; the Department of Biostatistics and Bioinformatics; the Department of Medicine; the Center for Palliative Care, Duke University Medical Center; the Center for Health Services Research, Durham Veterans Affairs Medical Center, Durham, NC; the Division of General Internal Medicine, Department of Medicine; the Institute for Doctor-Patient Communication; the Institute to Enhance Palliative Care, University of Pittsburgh School of Medicine; and the Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
Address reprint requests to Kathryn I. Pollak, PhD, Duke University Medical Center, Community and Family Medicine, 2424 Erwin Rd, Suite 602, Durham, NC 27705; e-mail: polla007@mc.duke.edu
Introduction: Cancer care involves addressing patient emotion. When patients express negative emotions, empathic opportunities emerge. When oncologists respond with a continuer statement, which is one that offers empathy and allows patients to continue expressing emotions, rather than with a terminator statement, which is one that discourages disclosure, patients have less anxiety and depression and report greater satisfaction and adherence to therapy. We studied whether oncologist traits were associated with empathic opportunities and empathic responses.
Patients and Methods: We audio-recorded 398 clinic conversations between 51 oncologists and 270 patients with advanced cancer; oncologists also completed surveys. Conversations were coded for the presence of empathic opportunities and oncologist responses. Analyses examined the relationship with oncologists' demographics, self-reported confidence, outcome expectancies, and comfort to address social versus technical aspects of care.
Results: In 398 conversations, 37% contained at least one empathic opportunity; the range was 0 to 10, and the total empathic opportunities was 292. When they occurred, oncologists responded with continuers 22% of the time. Oncologist sex was related to the number of empathic opportunities; female patients seen by female oncologists had the most empathic opportunities (P = .03). Younger oncologists (P = .02) and those who rated their orientation as more socioemotional than technical (P = .03) were more likely to respond with empathic statements.
Conclusion: Oncologists encountered few empathic opportunities and responded with empathic statements infrequently. Empathic responses were more prevalent among younger oncologists and among those who were self-rated as socioemotional. To reduce patient anxiety and increase patient satisfaction and adherence, oncologists may need training to encourage patients to express emotions and to respond empathically to patients' emotions.
Supported by National Cancer Institute Grant No. R01CA100387.
Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
