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한 말기 암환자와 의사와의 의사소통에 대한 대중의 반응: 3개의 온라인 기사 댓글에 대한 질적 연구

The Public's Response to Communication between a Terminal Cancer Patient and Physicians: A Qualitative Study of Three Sets of Online News Comments

  • 박송이 (동아대학교 의과대학 응급의학교실) ;
  • 박경혜 (연세대학교 원주의과대학 의학교육학과)
  • Park, Song Yi (Department of Emergency Medicine, Dong-A University College of Medicine) ;
  • Park, Kyung Hye (Department of Medical Education, Yonsei University Wonju College of Medicine)
  • 투고 : 2022.06.10
  • 심사 : 2022.07.25
  • 발행 : 2022.10.31

초록

This study explored the public's response to an incident involving publicity about how physicians broke bad news to a terminal cancer patient by analyzing 1,960 comments from three online news websites that reported on this event using Braun and Clarke's theme analysis methods. Three themes and 10 subthemes emerged from the public's responses to the way the physicians broke the bad news. Theme 1 (a physician is a person who tells the facts) contained the following subthemes: physicians are responsible for delivering facts, but it is a matter of consideration for patients to deliver bad news to them, empathy and consolation should be expected from people other than physicians, and physicians who say what patients want to hear are cheaters. Theme 2 (there is a problem with physicians) included the following subthemes: the physicians' empathy or personality and problems with their communication methods. Theme 3 (there are obstacles to communication with dying patients) had the following subthemes: physicians become emotionally dull and find it very stressful to break bad news, giving hope to dying patients can lead to medical disputes, and empathy and consolation are also costly. When breaking bad news, the physicians delivered factual information, but they did so inappropriately, and emotional support for the patient was insufficient. In medical communication education, it is necessary to emphasize training in emotional support. In the medical field, an environment should be created where physicians can communicate as they have learned.

키워드

과제정보

본 연구는 동아대학교 연구재단의 연구비 수혜를 받았다(no., 20220402).

참고문헌

  1. Buckman R. Breaking bad news: why is it still so difficult? Br Med J (Clin Res Ed). 1984;288(6430):1597-9. https://doi.org/10.1136/bmj.288.6430.1597
  2. Brown J, Noble LM, Papageorgiou A, Kidd J. Clinical communication in medicine. Chichester: John Wiley & Sons; 2016.
  3. Tanaka H, Tsukuma H, Masaoka T, Ajiki W, Koyama Y, Kinoshita N, et al. Suicide risk among cancer patients: experience at one medical center in Japan, 1978-1994. Jpn J Cancer Res. 1999;90(8):812-7. https://doi.org/10.1111/j.1349-7006.1999.tb00820.x
  4. Dosanjh S, Barnes J, Bhandari M. Barriers to breaking bad news among medical and surgical residents. Med Educ. 2001;35(3):197-205. https://doi.org/10.1046/j.1365-2923.2001.00766.x
  5. Baile WF, Beale EA. Giving bad news to cancer patients: matching process and content. J Clin Oncol. 2003;21(9 Suppl):49s-51s. https://doi.org/10.1200/JCO.2003.01.169
  6. Lamont EB, Christakis NA. Prognostic disclosure to patients with cancer near the end of life. Ann Intern Med. 2001;134(12):1096-105. https://doi.org/10.7326/0003-4819-134-12-200106190-00009
  7. Shaw JM, Brown RF, Dunn SM. A qualitative study of stress and coping responses in doctors breaking bad news. Patient Educ Couns. 2013;91(2):243-8. https://doi.org/10.1016/j.pec.2012.11.006
  8. Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM, Leaning MS, et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer. 1995;71(6):1263-9. https://doi.org/10.1038/bjc.1995.244
  9. Kang JA, Yoo YS, Park JN, Kim WC, Nam EJ, Koh SJ, et al. The effects of the pilot program in standard curriculum of hospice and palliative care education. J Hosp Palliat Care. 2008;11(4):206-12.
  10. Kim SH, Choi YS, Lee YM, Kim DG, Kim JA. Teaching 'breaking bad news' based on SPIKES protocol during family medicine clerkship. Korean J Med Educ. 2006;18(1):54-62.
  11. Yang HS. The effects of the opinion and quality of user postings on Internet news readers' attitude toward the news issue. Korean J Journal Commun Stud. 2008;52(2):254-81.
  12. Metaoloz Instagram [Internet]. Menlo Park (CA): Instagram; c2022 [cited 2022 Jun 7]. Available from: https://www.instagram.com/metaoloz/?igshid=YmMyMTA2M2Y=.
  13. Park SY, Kim H, Park KH, Park SM, Lee DE, Jung YH, et al. Emergency physicians' experience of communication about brain-death organ and tissue donation. Health Commun. 2021;16(1):25-33.
  14. Carroll B, Freeman B. Content analysis of comments posted on Australian online news sites reporting a celebrity admitting smoking while pregnant. Public Health Res Pract. 2016;26(5):2651660.
  15. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. https://doi.org/10.1191/1478088706qp063oa
  16. Munoz Sastre MT, Sorum PC, Mullet E. Breaking bad news: the patient's viewpoint. Health Commun. 2011;26(7):649-55. https://doi.org/10.1080/10410236.2011.561919
  17. Wittmann E, Beaton C, Lewis WG, Hopper AN, Zamawi F, Jackson C, et al. Comparison of patients' needs and doctors' perceptions of information requirements related to a diagnosis of oesophageal or gastric cancer. Eur J Cancer Care (Engl). 2011;20(2):187-95. https://doi.org/10.1111/j.1365-2354.2009.01169.x
  18. Park JN, Choi SE, Choi KM, Hong YS, Lee KS, Yang S. The disclosure of cancer diagnosis and its prognosis. J Hosp Palliat Care. 2004;7(2):169-78.
  19. Yun YH, Rhee YS, Nm SY, Chae YM, Heo DS, Lee SW, et al. Public attitudes toward dying with dignity and hospice.palliative care. J Hosp Palliat Care. 2004;7(1):17-28.
  20. Sep MS, van Osch M, van Vliet LM, Smets EM, Bensing JM. The power of clinicians' affective communication: how reassurance about non-abandonment can reduce patients' physiological arousal and increase information recall in bad news consultations: an experimental study using analogue patients. Patient Educ Couns. 2014;95(1):45-52. https://doi.org/10.1016/j.pec.2013.12.022
  21. Uchitomi Y, Mikami I, Kugaya A, Nakano T, Okuyama T, Akechi T, et al. Physician support and patient psychologic responses after surgery for nonsmall cell lung carcinoma: a prospective observational study. Cancer. 2001;92(7):1926-35. https://doi.org/10.1002/1097-0142(20011001)92:7<1926::AID-CNCR1711>3.0.CO;2-L
  22. Schofield PE, Butow PN, Thompson JF, Tattersall MH, Beeney LJ, Dunn SM. Psychological responses of patients receiving a diagnosis of cancer. Ann Oncol. 2003;14(1):48-56. https://doi.org/10.1093/annonc/mdg010
  23. Fallowfield L, Jenkins V. Effective communication skills are the key to good cancer care. Eur J Cancer. 1999;35(11):1592-7. https://doi.org/10.1016/S0959-8049(99)00212-9
  24. Mehta PN. Communication skills: breaking bad news. Indian Pediatr. 2008;45(10):839-41.
  25. Burgers C, Beukeboom CJ, Sparks L. How the doc should (not) talk: when breaking bad news with negations influences patients' immediate responses and medical adherence intentions. Patient Educ Couns. 2012;89(2):267-73. https://doi.org/10.1016/j.pec.2012.08.008
  26. Lee Y, Lee Y. A guide to communication with cancer patients. Seoul: Doctor's Book Co.; 2012.
  27. Yeob KE, Kim SY, Park BR, Shin DW, Yang HK, Park K, et al. Burnout Among oncologists in the Republic of Korea: a nationwide survey. Curr Probl Cancer. 2020;44(1):100535. https://doi.org/10.1016/j.currproblcancer.2019.100535
  28. Seo JH, Bae HO, Kim BJ, Huh S, Ahn YJ, Jung SS, et al. Burnout of faculty members of medical schools in Korea. J Korean Med Sci. 2022;37(9):e74. https://doi.org/10.3346/jkms.2022.37.e74