나쁜 소식 전하기 증례보고: 암진단 알리기
Communication Skills: Telling the Diagnosis of Cancer
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환자와 그 가족에게 암 진단을 알리는 일은 결코 쉬운 일이 아니며, 나쁜 소식은 아무리 조심스런 표현일지라도 환자와 그 가족은 편안하게 받아들이기가 어렵다. 전신적 무력감과 흑색 변을 주소로 내원한 43세 남자 환자가 간으로 전이된 진행성 위암으로 확진되었다. 의료진은 이 소식을 환자와 가족들에게 검사의 진행에 따라 단계적으로 알려 주었으며 환자와 가족의 심리적인 반응을 이해하고 필요한 지지를 제공하였다. 그 과정에서 경험한 의료진과 환자, 환자 가족 내의 갈등 및 문제 해결 방법을 정리하였고 문헌을 고찰하였다. 의사는 경험의 축적, 의사소통 기술에 대한 교육 및 환자 면담에 대한 충분한 사전 준비를 통해 나쁜 소식 전달에 대한 부담을 줄일 수 있다. 미국이나 일본과는 달리 한국은 아직 환자에게 나쁜 소식 전하기에 대하 교육과 수련이 부족하다. 향후 이에 대한 한국 실정에 맞는 기준 정립이 필요하다
Abstract
Breaking bad news to patients with a advanced cancer is a difficult task for physicians. Some strategies can be used when breaking bad news to patients with advanced cancer. However, many doctors were not trained sufficiently. 43-year old male complaining of general weakness and melena was diagnosed as an advanced gastric cancer with hepatic metastasis. We could deliver this bad news to the patient and his family step by step. Honest discussion allowed patient to be reassured about many points of concern and helped them to be calmer and to plan and readjust hopes and aims. Bad news cannot be broken gently, but it can be given in a sensitive manner and at the individual's pace. Sometimes doctor's own anxiety can be barrier to tell the truth. When we give the information, we always keep in mind about the respect for truth, the patient's rights, the duty to inform, maintaining hope, and the sanctity of the individual contract between patient and doctor.
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