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Introdução: A comunicação médico-doente eficaz é fundamental para a otimização dos cuidados centrados no doente. Este estudo pretendeu identificar a concordância entre a informação facultada pelo médico e a percecionada pelo doente, no decurso da consulta de Oncologia Médica (OM) e explorar os fatores potencialmente associados à ineficácia da comunicação.
Metodologia: Realização de inquérito por entrevista semi estruturada a doentes com cancro incurável e oncologistas após consulta de OM de 1ª vez. Análise da concordância recorrendo a estatística descritiva e dos dados qualitativos utilizando a análise temática.
Resultados: Foram realizadas 13 pares de entrevistas (12 oncologistas e 13 doentes). Relativamente ao diagnóstico verificou-se elevada concordância quando se avaliou o que o doente sabia previamente (85%) e se de fato a informação foi efetivamente transmitida (80%)e reduzida quando se explorou a necessidade de receber informação nova (38%). Relativamente ao tratamento a concordância foi superior para o tipo de tratamento(80%) comparativamente à discussão dos efeitos secundários (61%) e resultados esperados (61%). No que diz respeito ao processo de tomada de decisão a concordância foi de 92% para a preferência do doente e de 80% para a participação neste processo.Acerca do prognóstico a concordância foi de 54 % para a avaliação da necessidade de informação e de 38% para a discussão deste tema. Quanto aos fatores que influenciam a comunicação médico-doente foram identificados 3 temas: “o doente não está sozinho”, “o doente tem um passado” e “reação comportamental face à doença”.
Conclusões: O grau de concordância depende do tema discutido sendo manifestamente inferior na discussão de prognóstico em comparação com outros temas. O doente identifica múltiplos fatores que interferem com a comunicação, relacionados com os vários intervenientes, com experiências prévias e com o impacto social e emocional da doença,confirmando a complexidade e a bilateralidade deste processo.
Introduction: Effective patient-physician communication is essential to optimize patient-centred care. The study aim is to analyse the degree of agreement between the information provided by the physician and perceived by the patient during the first Medical Oncology (MO)appointment, and to explore factors potentially associated with ineffective communication. Methodology: Semi-structured interviews with incurable cancer patients and their oncologists were conducted after the first MO appointment. Agreement analysis was done using descriptive statistics and qualitative data were studied using thematic analysis. Results: Thirteen pairs of interviews were carried out (12 oncologists and 13 patients). Regarding the diagnosis, there was a high level of agreement when assessing what the patient previously knew (85%) and whether the information was actually transmitted (80%), and reduced when the need to receive new information was explored (38%). Concerning thetreatment, agreement was higher for the type of treatment (80%) compared to the discussion of side effects (61%) and of the expected results (61%). In terms of decision making process, the agreement was 92% for the patient's preference and 80% for participation in this process. As for the prognosis, the agreement was only 54% for the assessment of the need for information and 38% for the discussion of this topic. The investigation of factors that influence patient- physician communication identified 3central themes: “the patient is not alone”, “the patient has a past” and “behavioural reaction to the disease”. Conclusions: The level of agreement depends on the topic under discussion. Compared to other topics, it is clearly less when prognosis is concerned. The patient identifies multiple factors interfering with communication, regarding the different agents, previous experiences, and social and emotional impact of the disease, thus confirming the complexity and the bilateral nature of this process.
Introduction: Effective patient-physician communication is essential to optimize patient-centred care. The study aim is to analyse the degree of agreement between the information provided by the physician and perceived by the patient during the first Medical Oncology (MO)appointment, and to explore factors potentially associated with ineffective communication. Methodology: Semi-structured interviews with incurable cancer patients and their oncologists were conducted after the first MO appointment. Agreement analysis was done using descriptive statistics and qualitative data were studied using thematic analysis. Results: Thirteen pairs of interviews were carried out (12 oncologists and 13 patients). Regarding the diagnosis, there was a high level of agreement when assessing what the patient previously knew (85%) and whether the information was actually transmitted (80%), and reduced when the need to receive new information was explored (38%). Concerning thetreatment, agreement was higher for the type of treatment (80%) compared to the discussion of side effects (61%) and of the expected results (61%). In terms of decision making process, the agreement was 92% for the patient's preference and 80% for participation in this process. As for the prognosis, the agreement was only 54% for the assessment of the need for information and 38% for the discussion of this topic. The investigation of factors that influence patient- physician communication identified 3central themes: “the patient is not alone”, “the patient has a past” and “behavioural reaction to the disease”. Conclusions: The level of agreement depends on the topic under discussion. Compared to other topics, it is clearly less when prognosis is concerned. The patient identifies multiple factors interfering with communication, regarding the different agents, previous experiences, and social and emotional impact of the disease, thus confirming the complexity and the bilateral nature of this process.
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Comunicação médico doente Consulta de oncologia médica de 1ª vez Fatores que influenciam a comunicação Prognóstico Comunicação de más notícias Physician-patient communication First-time medical oncology appointment Factors that influence communication Prognosis Bad news communication