Research of the fulfillment of medical staffs’ explaining obligation to the cancer patients

王毓倩 李航

【Abstract】Its always a dilemma between medical staffsexplaining obligation and patientsinformed consent right，especially right for cancer patients.In recent years，as the cancer incidence has increased and showed younger trend，how to fulfill explaining obligation to cancer patient has become a topic worth studying.This article emphasizes particularly on the concrete measures of how to fulfill explaining obligation to cancer patients，in the hope that cancer patients can be treated with dignity，medical staffslawful rights can be protected and medical disputes caused during this progress can be properly solved through the practice of medical staffsscientific explaining.

【Key word】medical staffsexplaining obligation； cancer patients

Named“malignancy”in medical terminology，cancer now has become the primary disease cause of death worldwide.According to reports in 2013，cancer incidence is on the rise and shows younger trend in China.Thus，how to develop humanized and harmless explaining strategies and methods for cancer patients has turned into an important issue for medical staffs to think over.As society advances，people have changed their attitudes towards the idea of whether to tell cancer patients the true condition or not.Therefore，its of general clinical significance to return to “patients-based” thought and explore the way of fulfilling explaining obligation to cancer patients.

1.Status quo

1.1 Status quo of legislation

In China，medical staffsexplaining obligations have been specified in article No.55 of Tort Liability Law，article No.26 of“The Law for Licensing Medical Practitioner”，article No.11 of“The Regulation on the Handling of Medical Accidents”and article No.33 of “The Regulations on Administration of medical institutions”.From “informing”to “explaining”，obligation transformation suggests a higher demand for medical staffs.

1.2 The explaining objects

The explaining objects from relatives of patients to patients （adverse effects should be avoided while explaining） suggest the return of “patients-based” thought and increasing attention to patientsinformed consent rights.However，without systematic learning and training，medical staffsexplaining of cancer diagnosis to the patients can be risky.Our research results of explaining techniques to cancer patients in recent years have demonstrated the feasibility，but the fulfillment should be based on the protection of cancer patientsright to live rather than just blindly emphasize the protection of cancer patientsinformed consent right.

1.3 Explaining scopes and trends

With social progress，medical technology development and improvement of peoples comprehensive quality，doctors begin to change their minds.More and more doctors realize that，to some extent，it will not only be beneficial to win patients understanding and cooperation in coping with illness and achieve the best therapeutic effect，but also show respect for patients personality by honestly telling patients their condition.

2.Existing Problems

2.1 Obstacles（problems） caused by miscommunication and mutual distrust

From the education process schedules of major medical colleges，we can see that most of these medical colleges emphasize the training of medical technology rather than humanistic qualities.“Doctor-patient communication and informing skills” and related courses are just optional，resulting in not getting systematic informing skills training for medical students.

2.2 Legal deficiency for obligation scope，standard and specific exemptions

Throughout all the related laws and regulations，there are only regulations that define“medical staffs have the obligation”，but no definitions of the obligation scopes，standards and specific exemptions.

2.3 Lack of supervision system

Most of the doctor-patient communication related departments established by medical institutions are just“go through the motions”，those departments cant achieve desired results in solving problems of miscommunication with cancer patients，meanwhile，the fulfillment by medical staffsof health administrative departments lack strict supervision.

3.Concrete advice and measures

3.1Enhance the guidance for standardized and normalized fulfillment of obligation

“The guiding principle for cancer patientsinformed consent”was ethical file made by humanistic medicine departments from 24 hospitals and 8 universities along with 6 academic societies in 2008.So far，its the file with a relatively detailed introduction to the fundamental principle of cancer disease informing in our country，and it was made with reference to SPIKES of American Society of Clinical Oncology （ASCO）.Therefore，we suggest to make laws and regulations about cancer patientsinformed consent that are more scientific，detailed and suitable for our national situation based on the principle.

3.2 Detailing the explaining obligation clause by defining its contents，scopes，standards and exemptions.

According to the investigation and evaluation of cancer patients，medical staffs should make up communication teams with cancer patients and their families based on different ages，genders，education levels，lifestyles，life experience，characters，values，thanatopsis，working and living conditions，social statuses，endurances，recognitions，etc.Once the team gets approval from superior doctor，it can carry out explaining program that is more targeted.

Only exemptions get clearly defined，will the medical staffs not go so far as to do defensive explaining，which helps to centre on the protection of cancer patientsinterests and improve cancer patientsquality of life ，thereby safeguarding the medical effects.

3.3 Improve the evaluation system of admission to hospital for cancer patients； make questionnaire about cancer patients information requirements.

Once cancer patients get definite diagnoses，the first visited medical institution should create profiles for them.Also the hospital should make questionnaire about their information requirements and evaluate from multi-aspect，thus saving the medical costs and improving treatment efficiencies，showing more respect and humanization for cancer patients.

3.4 Enhance explaining skills training

Organizations like medical institutions，Chinese Medical Doctor Association，China health law society should carry out training course about explaining skills for medical staffs.Medical institutions should establish relevant appraisal mechanism and measure the course by class hour.Only accomplish a certain amount of class hours in a year，can they pass the examination.

3.5 Enhance the psychological counseling and construction for caner patients

Medical staffs should start realistic communication model with cancer patients.By means of chatting or communication，medical staffs can earn the trust of cancer patients and their families，thereby acquiring every cancer patients psychic reaction stages when they know the conditions.So，medical staffs can take targeted measures toward different evaluation results like emotional shock stage，quest and withdrawal stage or calm to accept stage.

作者簡介：

王毓倩，女，28歲，瀘州醫學院，法律碩士，研究方向：醫事法律。

李航，男，29歲，瀘州醫學院，法學學士，研究方向：醫事法律。