NEJM Audio Summary - Oct 25, 2012（3）

Mac用のテープ起こしのためのツール"CasualTranscriber"が非常に便利で、今週３記事目。和訳は、呼吸器内科医さんの「癌患者は、抗癌剤治療に過度の期待を持つ傾向がある」を参照してください。

[00:07:16]
"Patients' expectations about effects of chemotherapy for advanced cancer", by Jane Weeks from Dana-Farber Cancer Institute, Boston. The authors characterize the prevalence of the expectation among patients with metastatic lung or colorectal cancer that chemotherapy might be curative and to identify the clinical, sociodemographic, and health-system factors associated with this expectation. Overall, 69% of patients with lung cancer and 81% of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer. The risk of reporting inaccurate beliefs about chemotherapy was higher among patients with colorectal cancer, as compared with those with lung cancer among nonwhite and Hispanic patients, as compared with non-Hispanic white patients and among patients who rated their communication with their physician very favorably, as compared with less favorably. Educational level, functional status, and the patient's role in decision making were not associated with such inaccurate beliefs about chemotherapy. Many patients receiving chemotherapy for incurable cancers may not understand that chemotherapy is unlikely to be curative, which could compromise their ability to make informed treatment decisions that are consonant with their preferences. Physicians may be able to improve patients' understanding, but this may come at the cost of patients' satisfaction with them.
[00:08:53]
In editorial Thomas Smith from the Johns Hopkins University School of Medicine, Baltimore writes that truthful conversations that acknowledge death help patients understand their curability, are welcomed by patients, and do not squash hope or cause depression. This is not one hard conversation for which we can muster our courage but a series of conversations over time from the first existential threat to life. The editorialist recommend stating the prognosis at the first visit, appointing someone in the office to ensure there is a discussion of advance directives, helping to schedule a hospice-information visit within the first three visits, and offering to discuss prognosis and coping ("What is important for you?") at each transition. ( 322 words / 146 sec = 132 wpm)