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首页> 外文期刊>Qualitative health research >The reconfiguration of expertise in oncology: the practice of prediction and articulation of indeterminacy in medical consultations.
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The reconfiguration of expertise in oncology: the practice of prediction and articulation of indeterminacy in medical consultations.

机译：肿瘤学专业知识的重新配置：医学会诊中不确定性的预测和明确表达的实践。

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摘要

Evidence-based medicine has enhanced the predictive capacity of biomedicine in population terms, but it has also introduced new challenges for patient care and biomedical expertise. In this article we examine the negotiation of prediction and indeterminacy by oncology clinicians, exploring the ways in which they report delivering prognosis and engaging with indeterminacy in conversation with their patients. We examine oncologists' strategies for delivering "news," the technological mediation of uncertainty, and reported conversational turns toward a focus on indeterminacy and individual response. Drawing from these accounts, we argue that, although predictive capacity remains central to oncological expertise, notions of individualism, subjectivity, and self-determination are being heavily drawn on by clinicians. Rather than presenting a challenge, such ideas might be becoming increasingly central to oncological expertise. Interviews with cancer nurses illustrate their precarious relationship with evidence, uncovering tensions in their approach to patients and in their attempts to traverse diverse paradigms of care. We argue for an understanding of oncological expertise as evolving within the context of potentially competing contemporary cultural shifts, and against a simplistic notion of indeterminacy as necessarily eroding expertise.
机译：循证医学提高了人口生物医学的预测能力，但也给患者护理和生物医学专业知识带来了新的挑战。在本文中，我们检查了肿瘤临床医生对预测和不确定性的协商，探讨了他们报告提供预后以及与患者交谈时不确定性的方式。我们研究了肿瘤学家提供“新闻”，不确定性的技术中介的策略，并报告了谈话转向转向不确定性和个人反应。从这些描述中，我们认为，尽管预测能力仍然是肿瘤学专业知识的中心，但临床医生仍大量采用个人主义，主观性和自决力的概念。这些想法可能不会成为挑战，而是在肿瘤学专业知识中变得越来越重要。与癌症护士的访谈说明了他们与证据之间car可危的关系，揭示了他们对待患者的方式以及他们尝试遍历各种护理范例的压力。我们主张对肿瘤学专业知识的理解是在潜在竞争的当代文化转变的背景下发展的，并且反对不确定性的简单化概念，因为不确定性必然侵蚀专业知识。

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