Ayşe Arzu YORGANCIOĞLU, Tuğba GÖKTALAY, Ayşın COŞKUN ŞAKAR, Yavuz HAVLUCU, Utku DATLI, Pınar ÇELİK

Hekimlerin, hasta yakınlarının ve toplumun akciğer kanseri tanısının söylenmesine ilişkin görüşlerinin değerlendirilmesi

Ülkemizde genellikle hasta yakınlarına bırakılan bir karar olan, akciğer kanserli hastalara tanının söylenmesi konusunda tanı koyan, tedavi veren hekimlerin, birinci derece akrabası akciğer kanserli hasta yakınlarının ve toplumun görüşlerinin değerlendirilmesi amacı ile bir anket çalışması düzenlendi. Materyal ve Metod: Çalışmaya yaş ortalaması 39.37 ± 11.44 olan, 170'i kadın toplam 310 olgu alındı (100 tıp hekimi, 110 hasta yakını, 100 sağlıklı gönüllü). Hekimlerin %46'sı kliniğinde kanser tedavisi (KT/RT) uyguluyordu.Bulgular: "Akciğer kanseri tanısı alsaydınız tanıyı öğrenmek ister miydiniz?" sorusuna olguların %84.5'i "evet" yanıtı vermişti, gruplar arasında dağılım benzer bulundu (p> 0.05). Hekimlerin %72'si akciğer kanseri tanısını hastalarına söylerken, kanser tedavisi uygulayan hekimlerde %89.1, uygulamayanlara (%57.4) göre yüksek bulundu (p< 0.05). Akciğer kanseri tanısını zamana yayarak anlayabileceği şekilde duyma isteği hekimlerde %19, toplumda %34 ve hasta yakınlarında %59 oranında saptanmıştır (p< 0.05). Yaşam kalitesi bilgisi hasta yakınları (%87) tarafından, toplum (%65) ve hekimlere (%63) göre daha fazla önemsenmektedir (p< 0.05). Yaşam kalitesini kanser tedavisi uygulayan hekimler (%76.7), uygulamayan hekimlere (%48.8) göre daha fazla önemsemektedir (p< 0.05). Araştırmaya katılanların çocuk sayısı arttıkça son dönemlerini aile ile geçirme isteği de artmaktadır (p< 0.05). Sonuç: Hekimlerin hasta ve yakınlarına tanıyı anlayabilecekleri şekilde bilimsel verilerle, gereğinde zamana yayarak söylemesinin, tedavi ve yan etkiler hakkında bilgilendirme yapmasının, hastanın yaşam kalitesini önemsemesinin, hastanın güvenini kazanmasını sağlayacağı ve bu durumun tedaviye uyumu artıracağı düşünülmektedir.

Evaluation of physians, patients, relatives and society of opinions on the told lung cancer diagnosis

In our country, this is usually done by patientrelatives. In this study, we aimed to investigate the thought ofdoctors who done the diagnosis, doctors who arrange thetreatment, first degree relatives of patients with lung cancer, andpopulation as a controlMaterials and Methods: 310 subjects (100 doctors, 110 first degree realtives of patients, and 100 subjects as a control) were includedto the study. The mean age was 39.77 ± 11.44 years and there was 170 females. 46% of doctors were giving cancer treatment(chemotheraphy/radiotheraphy).Results: 84.5% of subjects were answered the question (Do you want to know the diagnosis of lung cancer if you are lung cancer?)as "yes" and the answers were not different between groups (p> 0.05). 72 of doctors were giving information about diagnosis ofpatients. This ratio was 89.1% in doctors who arrange lung cancer treatment whereas it was 57.4% in doctors who do not arrangecancer treatment. The percent age of learning of diagnosis of lung cancer throughout the time in doctors, population, and patient'srelatives were 19%, 34%, and 59% respectively (p< 0.05). Information about quality of life was more important in relatives ofpatients (87%) than population (65%) and doctors (63%) (p< 0.05). Quality of life was more important for doctors who arrangelung cancer treatment (76.7)% than doctors who did not (48.8%) (p< 0.05). Patients who were more children wanted to stay withtheir family at end stage of disease (p< 0.05).Conclusion: According to this study we think that doctors should say the diagnosis of lung cancer in the form of they understand,inform the patients and relatives about treatment, and quality of life and this can increase patient trust to doctor and compliance ofpatients to the treatment.

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1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.
2. Göksel T, Akkoclu A; Turkish Thoracic Society, Lung and Pleural Malignancies Study Group. Pattern of lung cancer in Turkey, 1994-1998. Respiration 2002;69:207-10.
3. Jett JR, Midthun D. Screening for lung cancer: current status and future directions: Thomas A. Neff lecture. Chest 2004;125(Suppl 5): S158-62.
4. Özkan S. Psikiyatrik ve psikososyal açıdan kanser konsültasyon liyezon psikiyatrisi kongre kitabı 1998-1999. İstanbul:140-53.
5. Espinosa E, Gonzalez BM, Zomora P, Ordonez A, Arranz P. Doctors also suffer when giving bad news to cancer patients. Support Care Cancer 1996;4:61-3.
6. Ozdogan M, Samur M, Bozcuk HS, Coban E, Artac M, Savas B, et al. "Do not tell": what factors affect relatives' attitudes to honest disclosure of diagnosis to cancer patients? Support Care Cancer 2004;12:497-502.
7. Benson J, Britten N. Respecting the autonomy of cancer patients when talking with their families: qualitative analysis of semistructured interviews with patients. BMJ 1996;313:729-31.
8. Surbone A. Telling the truth to patients with cancer: what is the truth? Lancet Oncol 2006;7:944-50.
9. Oksuzoglu B, Abali H, Bakar M, Yıldrım N, Zengin N. Disclosure of cancer diagnosis to patients and their relatives in turkey: views of accompanying persons and influential factors in reaching those views. Tumori 2006;92:62-6.
10. Uçar N, Aksu F, Alpar S, Güven S, Örsel O, Kurt B. Akciğer kanseri tanısı hastaya söylenmeli mi? (Anket Çalışması). Solunum Hastalıkları 2007;18:148-56.
11. Faridhosseini F, Ardestani MS, Shirkhani F. Disclosure of cancer diagnosis: what Iranian patients do prefer? Ann Gen Psychiatry 2010;9(Suppl 1):S165.
12. Vahdaninia M, Montazeri A. Cancer patient education in Iran: attitudes of health professionals. Payesh 2003;2:259- 65.
13. Hoff L, Tidefelt U, Thaning L, Hermeren G. In the shadow of bad news-views of patients with acute leukaemia, myeloma or lung cancer about information, from diagnosis to cure or death. BMC Palliat Care 2007;6:1.
14. Wood WA, McCabe MS, Goldberg RM. Commentary: disclosure in oncology-to whom does the truth belong? Oncologist 2009;14:77-82.
15. Ruhnke GW, Wilson SR, Akamatsu T, Kinoue T, Takashima Y, Goldstein MK, et al. Ethical decision making and patient autonomy: a comparison of physicians and patients in Japan and the United States. Chest 2000;118:1172-82.
16. Hamadeh GN, Adib SM. Cancer truth disclosure by Lebanese doctors. Soc Sci Med 1998;47:1289-94.
17. Numico G, Anfossi M, Bertelli G, Russi E, Gento G, Silvestris N, et al. The process of truth disclosure: An assessment of the results of information during the diagnostic phase in patients with cancer. Ann Oncol 2009;20:941-5.
18. Noore I, Crowe M, Pilley I. Telling the truth about cancer: views of elderly patients and their relatives. Ir Med J 2000;93;104-5.
19. Doruk S, Sevinç C, Sever F, İtil O, Akkoçlu A, The trends of relevance about telling lung cancer diagnosis: social constraints, medical pratice in Several Clinics. Tuberk Toraks 2012;60:336-43