How to eliminate the excessive expectations or questions of chemotherapy for patients with advanced cancer?The Second Affiliated Hospital of
How to eliminate the excessive expectations or questions of chemotherapy for patients with advanced cancer?
The Second Affiliated Hospital of Medical College of Zhejiang University Wang Liancong tumor radiotherapy director
In October 25, 2012 the new England Journal of medicine "[N Engl J Med 2012367 (17): a survey of American scholar Weeks 1616] published the results show: accept metastatic chemotherapy in 1193 cases (IV) in cancer patients, 69% lung cancer patients and 81% colorectal cancer patients do not understand the chemotherapy is non healing. General chemotherapy expectations are too high, and false expectations has nothing to do with the factors of the patients with education level and social status. The researchers believe that this may be detrimental to the patient's right to know, and thus make their own will not be consistent with the treatment decisions.
The situation is not entirely consistent with the United States, in the traditional concept of China "talking about cancer" and the current medical environment, know our cancer patients may not only related to doctors and patients, sometimes patients themselves is often the last one to know.
Why do patients with advanced cancer expect too much chemotherapy? Smith Johns Hopkins University and Professor Longo believes that people at the beginning of a laborious work, used to underestimate the complete difficulty, too confident, Kahneman (Nobel Laureate) called "the planning fallacy (Planning Fallacy)". Of course, optimism reduces the fear of death to some extent, and when it comes to asking a patient who is close to death, "what happens to the treatment you receive, there is also a high level of expectation.". The reason is probably the patients surveyed completely is not tell the patient or not effectively convey, also may be the patient chose not to believe, or patients fully understand but to stranger questions are too confident. Although Weeks's study did not mention these, but many observational studies have shown that most American doctors would tell in newly diagnosed patients with incurable disease, even when patients know the truth, some people are reluctant to admit, you know, after a diagnosis of cancer, people's way of thinking may change.
The real problem: chemotherapy (not including radiotherapy) is the main treatment for most metastatic tumors, although the efficacy of chemotherapy for decades has increased, but for patients with advanced cancer chemotherapy, the study of the role of only a few months to extend survival, often only as a therapy rather than a cure.
Almost all the patients want to know the prognosis of disease, often only in the real information, know exactly what will happen to them, in the final stage of life, make wise choices. Doctors have many ways to help patients make these difficult decisions, the doctor and the patient on the death of a sincere conversation to help patients understand the disease, and will not suppress emotions.
A physician should master the skills necessary to ask and inform. Recommended in the first visit, to ensure a full discussion of the condition after explain to the patient prognosis, and provide hospice information in the first three consultations; each transition in conversation are concerned about the pressure of the patient; encourage patients to accept hospice and palliative care. Doctors can more effectively share more information with patients, so that they can better arrange the rest of life. After all, people want to live longer when they have a good quality of life, and then leave quietly outside the hospital.
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