肺癌的社会身份：改善外科协作决策的历史洞察
Lung Cancer's Social Identity: Historical Insights to Improve Collaborative Decision-Making for Surgery.
作者
作者单位
- Faculty of Medicine, University of Ottawa. Electronic address: rena.seeger@uottawa.ca.
- The Ochsner Transplant Institute, The Ochsner Clinic.
- Department of Surgery, University of Ottawa; Division of Thoracic Surgery, University of Ottawa.
- Faculty of Medicine, University of Ottawa.
摘要
中文
胸外科医生在肺癌治疗中的角色在过去一个世纪中发生了显著变化。曾经被视为权威的技术专家，如今他们在更为复杂的临床和社会领域中穿行。随着专业积累了可行的技术干预，胸外科医生不仅继续作为技术大师和医学专家，还成为多学科团队和多模式治疗的协调者。肺癌独特的社会身份进一步表明，协调肺癌手术的外科医生还必须成为共享决策（SDM）的专家引导者。本研究采用历史研究方法，探讨肺癌的临床现实和社会身份如何演变得比其他癌症更为独特复杂，以及这种复杂性如何对参与协作决策的外科医生和患者提出格外困难的要求。多种诊断至手术路径的出现以及对吸烟和肺癌的污名化等因素，使肺癌手术的决策动态更为复杂。基于这些历史洞察，建议外科医生不仅将 SDM 视为对患者自主性的尊重姿态，更应将其视为临床实践的重要组成部分，将认知和情感沟通工作与患者整合——患者在参与决策讨论时（无论是否意识到）都会将肺癌复杂的社会身份带入其中。更深入地理解这些对话如何变得如此临床和社会复杂，以及审慎考虑患者如何受肺癌社会文化背景的影响，可以帮助外科医生更有效、更合乎伦理地促进共享决策。
English
The role of thoracic surgeons in treating lung cancer has evolved significantly over the past century. Once viewed as authoritative technical experts, today they navigate far more complex clinical and social terrain. As the specialty amassed viable technological interventions, thoracic surgeons have continued as master technicians and medical experts but are also coordinators of interdisciplinary teams and multimodal treatment. Lung cancer's particular social identity, moreover, suggests that surgeons who coordinate lung cancer surgery must also become expert facilitators of shared decision-making (SDM). Using historical research methods, this study explores how lung cancer's clinical realities and social identity emerged as uniquely complex compared to other cancers, and how this complexity makes exceptionally difficult demands on surgeons and patients when they engage in collaborative decision-making. Factors such as the emergence of multiple diagnosis-to-surgery pathways and the stigmatization of smoking and lung cancer contributed to more complex decision-making dynamics for lung cancer surgery. Based on these historical insights, surgeons are encouraged to view SDM not merely as a gesture of respect for patient autonomy, but also as an essential part of clinical practice that integrates cognitive and emotional communication work with patients-patients who bring lung cancer's complicated social identity with them (whether they realize it or not) into decision-making discussions. Greater understanding of how these conversations became so clinically and socially complex, and judicious consideration of how patients are influenced by lung cancer's socio-cultural contexts, can help surgeons facilitate SDM more effectively and ethically.
分类与指标
- 研究类型
- 综述Meta
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 9.8
- 新锐分区
- 1区