会话分析视角下癌症坏消息告知研究
A Study of Cancer Bad News Delivery from the Perspective of Conversation Analysis
摘要: 基于会话分析的理论框架，本研究以我国医疗人文纪录片《生生》中的医患对话为语料，就医生癌症坏消息传递的话语策略展开分析，并探讨医患坏消息告知的沟通技巧。研究发现，医生在坏消息告知中主要采用直接和间接两种策略，而其中直率策略占据主导地位。医生在解释坏消息时既有西方相似的准备策略，也有符合我国国情的使用比喻等特色。此外，研究还发现，我国医生在传递坏消息时往往以积极的方式进行，甚至将好消息融入其中。因此，未来医生在进行坏消息告知时应全面考虑患者及家属的情况，设计适合中国国情的坏消息传递模式，以促进良好的医患关系的构建。
Abstract: Based on the theoretical framework of conversation analysis, this study takes the doctor-patient interactions in the Chinese medical humanities documentary “Sheng Sheng” as the corpus, analyzes the discourse strategies used by doctors in delivering bad news about cancer, and explores the communication techniques of delivering bad news to cancer patients. The study found that doctors mainly use direct and indirect strategies in delivering bad news, with the direct strategy being dominant. Furthermore, when explaining bad news, doctors employ both preparation strategies similar to those in the West and Chinese-specific features such as the use of metaphors. Additionally, the research also revealed that Chinese doctors often convey bad news in a positive manner, even incorporating good news into the conversation. Therefore, in the future, doctors should comprehensively consider the circumstances of both patients and their families when delivering bad news, and design a bad news delivery model that is suitable for the Chinese context, in order to promote the establishment of a good doctor-patient relationship.
文章引用：廖晨欢. 会话分析视角下癌症坏消息告知研究[J]. 现代语言学, 2024, 12(6): 300-308. https://doi.org/10.12677/ml.2024.126465

参考文献

[1] Buckman, R. (1984) Breaking Bad News: Why Is It Still So Difficult? British Medical Journal, 288, 1597-1599. [Google Scholar] [CrossRef] [PubMed]
[2] Maynard, D.W. (1997) The News Delivery Sequence: Bad News and Good News in Conversational Interaction. Research on Language & Social Interaction, 30, 93-130. [Google Scholar] [CrossRef] 
[3] Ptacek, J.T. and Eberhardt, T.L. (1996) Breaking Bad News. A Review of the Literature. JAMA: The Journal of the American Medical Association, 276, 496-502. [Google Scholar] [CrossRef] [PubMed]
[4] Baile, W.F., Buckman, R., Lenzi, R., Glober, G., Beale, E.A. and Kudelka, A.P. (2000) SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist, 5, 302-311. [Google Scholar] [CrossRef] [PubMed]
[5] Maynard, D.W., Cortez, D. and Campbell, T.C. (2016) ‘End of Life’ Conversations, Appreciation Sequences, and the Interaction Order in Cancer Clinics. Patient Education and Counseling, 99, 92-100. [Google Scholar] [CrossRef] [PubMed]
[6] Maynard, D.W. (1992) On Clinicians Co-Implicating Recipients’ Perspective in the Delivery of Diagnostic News. In: Drew, P. and Heritage, J., Eds., Talk at Work: Interaction in Institutional Settings, Cambridge University Press, 331-358.
[7] Maynard, D.W. (1997) The News Delivery Sequence: Bad News and Good News in Conversational Interaction. Research on Language & Social Interaction, 30, 93-130. [Google Scholar] [CrossRef] 
[8] Friedrichsen, M.J. and Strang, P.M. (2003) Doctors’ Strategies When Breaking Bad News to Terminally Ill Patients. Journal of Palliative Medicine, 6, 565-574. [Google Scholar] [CrossRef] [PubMed]
[9] Sparks, L., Villagran, M.M., Parker-Raley, J. and Cunningham, C.B. (2007) A Patient-Centered Approach to Breaking Bad News: Communication Guidelines for Health Care Providers. Journal of Applied Communication Research, 35, 177-196. [Google Scholar] [CrossRef] 
[10] Shaw, J., Dunn, S. and Heinrich, P. (2012) Managing the Delivery of Bad News: An In-Depth Analysis of Doctors’ Delivery Style. Patient Education and Counseling, 87, 186-192. [Google Scholar] [CrossRef] [PubMed]
[11] 刘慧琴. 医患交际中诊断消息的告知与回应[D]: [硕士学位论文]. 太原: 山西大学, 2009.
[12] 于国栋. 医患交际的会话分析研究[M]. 北京: 外语教学与研究出版社, 2011.
[13] 宋晓琳, 尹梅, 金琳雅. 中晚期癌症治疗中坏消息告知问题研究[J]. 中国医学伦理学, 2019, 32(12): 1571-1574, 1585.
[14] 陈其佳, 孔悦, 李芳. 会话分析视角下的医患坏消息告知研究[J]. 叙事医学, 2023, 6(1): 18-24+51.
[15] Sidnell, J. and Stivers, T. (2013) The Handbook of Conversation Analysis. Wiley Blackwell. [Google Scholar] [CrossRef] 
[16] Maynard, D.W. and Heritage, J. (2005) Conversation Analysis, Doctor-Patient Interaction and Medical Communication. Medical Education, 39, 428-435. [Google Scholar] [CrossRef] [PubMed]
[17] 吴会娟, 龙艺. 医患沟通中的协商策略探析[J]. 医学与哲学, 2018, 39(9): 36-40.
[18] 乔纳森·西尔弗曼, 苏珊·库尔茨, 朱丽叶·德雷珀. 医患沟通技巧[M]. 北京: 化学工业出版社, 2009.