Zusammenfassung
Eine gute Arzt-Patient-Kommunikation bildet die Grundlage für eine vertrauensvolle
Beziehung, gelungene Informationsvermittlung und gute Zusammenarbeit in der Behandlung
einer schweren Erkrankung wie Brustkrebs. Die Studie untersucht das Erleben und die
Zufriedenheit mit der Diagnosemitteilung sowie Zusammenhänge mit psychischer Belastung
bei 1 083 Brustkrebspatientinnen, die über das Hamburgische Krebsregister rekrutiert
wurden (Teilnahmequote 66 %). Die Diagnosestellung lag durchschnittlich 47 Monate
zurück (Range 18-78). Neben Fragen zum Erleben der Diagnosemitteilung wurden validierte
Fragebogen zur Erfassung von Angst, Depressivität, sozialer Unterstützung, Krankheitsbewältigung
und Lebensqualität eingesetzt. Die Situation der Diagnosemitteilung wird von 60 %
der Patientinnen als positiv eingeschätzt; 23,5 % wurden von einer vertrauten Person
begleitet. 90 % der Patientinnen, die begleitet wurden, schätzen dies als positiv
ein, während ein knappes Drittel der Patientinnen, denen die Diagnose allein mitgeteilt
wurde, diese Situation als negativ wahrnahmen (p < 0,001). Patientinnen, die von einer
vertrauten Person begleitet wurden, haben ein höheres Tumorstadium, schätzen die Diagnose
als belastender ein, haben ein höheres Ausmaß an Progredienzangst, sozialer Unterstützung
sowie emotionsbezogener Krankheitsverarbeitung und erhielten die Diagnose häufiger
in einem Krankenhaus als in einer ambulanten Praxis (p-Werte ≤ 0,05). Insgesamt erlebten
Frauen, die die Situation der Diagnosemitteilung (Begleitung / keine Begleitung) als
positiv einschätzen, die Diagnose Brustkrebs als psychisch weniger belastend als Patientinnen,
die die Situation als negativ bewerteten (p < 0,001). Patientinnen, die mit der Diagnosemitteilung
unzufrieden waren, haben eine höhere psychische Belastung und geringere psychische
Lebensqualität sowie häufiger den Wunsch nach psychosozialer Unterstützung (p < 0,05).
Die Ergebnisse unterstreichen die Bedeutung der Berücksichtigung der Bedürfnisse der
Patientinnen für die Zufriedenheit mit der Diagnosestellung.
Abstract
A good doctor-patient communication is central to a trustful relationship, successful
patient education and good compliance during the treatment of a severe illness such
as breast cancer. This study investigated the perception and satisfaction with breast
cancer disclosure and its association with psychological distress in 1 083 breast
cancer patients recruited through the Hamburg cancer registry an average of 47 month
following diagnosis (range 18-78) (66 % response rate). Questions for the measurement
of perceptions of the breast cancer disclosure and validated self-report questionnaires
to assess anxiety, depression, social support, coping and quality of life were used.
60 % of patients perceive the situation of the cancer disclosure as positive; 23.5
% were accompanied by a person familiar with the patient. 90 % of those patients accompanied
perceived this fact as positive, whereas nearly one third of the patients that were
told the cancer diagnosis alone perceived this situation as negative (p < 0.001).
Patients accompanied by a person familiar with the patient had a higher tumor stage,
estimated the cancer diagnosis as more distressing, had higher levels of fear of cancer
progression, social support, emotion-based coping and received the diagnosis more
often within a hospital than in an outpatient care facility (p-values ≤ 0.05). Patients
who perceive the situation of cancer disclosure (accompaniment / no accompaniment)
as positive, experience the breast cancer diagnosis as psychologically less distressing
as patients who perceive this situation as negative (p < 0.001). Patients that were
not satisfied with the cancer disclosure were observed to have higher levels of psychological
distress, a lower mental quality of life and expressed more often the need for psychosocial
support (p < 0.05). Results emphasize the importance of the consideration of patients
needs for the satisfaction with a breast cancer disclosure.
Schlüsselwörter
Diagnosemitteilung - Brustkrebs - psychische Belastung
Key words
cancer disclosure - breast cancer - psychological distress
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Dr. phil. A. Mehnert
Institut und Poliklinik für Medizinische Psychologie · Zentrum für Psychosoziale Medizin
· Universitätsklinikum Hamburg-Eppendorf
Martinistr. 52-S 35
20246 Hamburg
Telefon: +49 / 40 / 4 28 03 62 03
Fax: +49 / 40 / 4 28 03 49 40
eMail: mehnert@uke.uni-hamburg.de