پریشانی روانی در میان بیماران سرطانی و رضایت آگاهانه

This study examines the relationships between satisfaction with information provided, understanding of consent procedures, and levels of anxiety/depression in a sample of patients undergoing radiotherapy for cancer. One hundred patients completed a 13-item self-report questionnaire and the Hospital Anxiety and Depression Scale (HADS). Twenty-two percent of patients could not recall signing a consent form and, for those who did recall, the level of understanding for what they had consented to was patchy. One fourth of patients could not recall being told of the side-effects from radiotherapy and were unable to list even common side-effects, such as tiredness, skin irritation, and sickness. No patient had been told about the low risk of second malignancy. Twenty-eight percent of patients were unhappy with the amount of information offered to them. Thirty percent of patients reached caseness for adjustment disorder +/−anxiety/depression. Thirteen percent of patients reached caseness for major depression. There was a significant correlation between patients who scored highly on the HADS and dissatisfaction with the information provided. Clinical implications and possible mechanisms of these findings are discussed.

There are increasing demands for patients with cancer to receive better information about their disease and its treatment as a requirement for obtaining informed consent 1 and 2. Communication about diagnosis, treatment, and consent has important implications for psychological adjustment 3, 4 and 5. The faculty of clinical oncology has set a number of quality assurance standards concerned with obtaining informed consent and provision of information adequate for this [6]. Doctors underestimate both the amount and sort of information patients want [7] and often overestimate how effective they have been in imparting accurate information to them [8]. Individual patients vary considerably in their preferences for information [9]. Most patients value honest information sharing and very few decline to have specific information about their diagnosis and treatment when offered [10]. A blanket policy of showering patients with standardized information could be unhelpful and even detrimental to some [11]. Legalistic considerations, essentially seeking release from liability, can become confused with the moral imperative to respect autonomy and facilitate the best decision regarding treatment options [12]. The limited effectiveness of methods for helping patients to assimilate information leaves many dissatisfied with the process and at risk of poor psychological adjustment 13 and 14. Psychiatric morbidity among this patient population is high with between 25% and 33% of patients developing a general anxiety disorder, major depressive illness, or adjustment disorder within the first 2 years of diagnosis 15 and 16. Poor psychological adjustment has been shown to be related to the number of unresolved concerns that patients have regarding their illness [18].