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首页> 外文期刊>Surgical Endoscopy >Framing family conversation after early diagnosis of iatrogenic injury and incidental findings.
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Framing family conversation after early diagnosis of iatrogenic injury and incidental findings.

机译：在早期诊断出医源性损伤和偶然发现后进行家庭对话。

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BACKGROUND: Surgeons are rarely formally trained in giving bad news to patients. The aim of our study was to examine and compare techniques of disclosure of iatrogenic and incidental operative findings among surgical residents. METHODS: General surgery residents performed a laparoscopic cholecystectomy on the SurgicalSIM device in a mock operating room. Half (n = 8) were presented with a common bile duct injury, and half (n = 7) encountered metastatic gallbladder cancer during the operation. Both groups disclosed this information to a patient's scripted family member and completed a questionnaire. All encounters were videotaped and independently rated using a modified SPIKES protocol, a validated tool for delivering bad news. We compared disclosure of iatrogenic versus unexpected findings by year of training. Analysis was performed using the Mann-Whitney test. RESULTS: Regardless of the year of training, more residents were comfortable with disclosure of an incidental finding than disclosure of an iatrogenic injury (47 vs. 33%). Senior residents (PGY4-PGY5) had better ratings by SPIKES (p < 0.05), most notably for tailoring disclosure to what patient and family understand, exploring patient and family expectations, and offering to answer any questions (p < 0.05). Even though all residents felt more comfortable with disclosure of an incidental finding, the quality of the disclosure by SPIKES score was the same for iatrogenic and incidental operative findings (p = NS). CONCLUSION: In general, trainees are ill prepared for delivering bad news. Disclosure of iatrogenic injuries was more challenging compared to that of incidental findings. Senior residents do better than junior residents at delivering bad news.
机译：背景：外科医生很少接受过向患者传出坏消息的正规培训。我们研究的目的是检查和比较外科住院患者医源性和偶然手术发现的披露技术。方法：普通外科住院医师在模拟手术室中的SurgicalSIM设备上进行了腹腔镜胆囊切除术。一半（n = 8）表现为胆总管损伤，一半（n = 7）在手术过程中发生转移性胆囊癌。两组均向患者的脚本化家庭成员披露了此信息，并完成了问卷调查。使用修改后的SPIKES协议（经过验证的传递坏消息的工具）对所有相遇进行了录像和独立评估。我们比较了培训年份对医源性和意外发现的披露。使用Mann-Whitney检验进行分析。结果：无论接受何种培训，都比披露医源性伤害更愿意接受偶然发现（47％vs. 33％）。老年居民（PGY4-PGY5）的SPIKES评分较高（p <0.05），最显着的是根据患者和家人的了解量身定制披露，探究患者和家人的期望并愿意回答任何问题（p <0.05）。即使所有居民都对披露偶然发现更为满意，但对于医源性和偶然手术发现，通过SPIKES评分进行披露的质量是相同的（p = NS）。结论：总的来说，受训人员没有做好传递坏消息的准备。与偶然发现相比，医源性伤害的披露更具挑战性。在传递坏消息方面，高级居民比普通居民做得更好。

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