为了评估晚期癌症患者是否更喜欢外科医生在姑息手术情境下使用最佳情况/最坏情况（BC/WC）沟通框架而不是传统的风险/收益（R/B）框架，以此来确定患者偏好的沟通框架可能提高满意度和治疗结果。在一个以视频场景为基础的随机、双盲研究中，从2020年11月到2021年5月，晚期癌症患者观看了两个视频，描述了一个医患接触情境，在这个情境中，外科医生使用BC/WC或R/B框架讨论治疗方案。主要结果是患者偏好的视频外科医生。共有155名患者被邀请参与研究；66名患者被随机选择参与，其中58名患者完成了研究（平均年龄55.8±13.8岁，男性占比60.3%）。22名患者（37.9%，95%置信区间：25.4%-50.4%）偏好使用BC/WC框架的外科医生，21名患者（36.2%，95%置信区间：23.8%-48.6%）偏好使用R/B框架的外科医生，15名患者（25.9%，95%置信区间：14.6%-37.2%）没有偏好。对医学专业的高信任与偏好使用BC/WC框架的外科医生呈负相关（OR 0.83，95%置信区间为0.70-0.98，P=0.03）。BC/WC框架在外科医生倾听方面评分更高（4.6±0.7 vs. 4.3±0.9，P=0.03），并且对外科医生的值得信赖程度感到更加自信（4.3±0.8 vs. 4.0±0.9，P=0.04）。虽然外科医生使用BC/WC沟通框架并不被所有患者普遍偏好，但对患者来说与传统的R/B框架同样可接受，并在某些沟通方面获得更高评价。偏好使用BC/WC框架的外科医生与对医学专业的信任度较低相关。外科医生应考虑使用BC/WC框架，以个性化应对具有挑战性的临床讨论。Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

To evaluate if patients with advanced cancer prefer surgeons to use the best case/worst case (BC/WC) communication framework over the traditional risk/benefit (R/B) framework in the context of palliative surgical scenarios.Identifying patients' preferred communication frameworks may improve satisfaction and outcome measures during difficult clinical decision-making.In a video vignette-based randomized, double-blinded study from November 2020 to May 2021, patients with advanced cancer viewed two videos depicting a physician-patient encounter in a palliative surgical scenario in which the surgeon uses either the BC/WC or the R/B framework to discuss treatment options. The primary outcome was patients' preferred video surgeon.155 patients were approached to participate; 66 were randomized and 58 completed the study (mean age 55.8±13.8 y, 60.3% male). 22 patients (37.9%, 95%CI:25.4%-50.4%) preferred the surgeon using the BC/WC framework, 21 (36.2%, 95%CI:23.8%-48.6%) preferred the surgeon using the R/B framework, and 15 (25.9%, 95%CI:14.6%-37.2%) indicated no preference. A high trust in the medical profession was inversely associated with a preference for the surgeon using BC/WC framework (OR 0.83, 95%CI 0.70-0.98, P=0.03). The BC/WC framework rated higher for perceived surgeon's listening (4.6±0.7 vs. 4.3±0.9, P=0.03) and confidence in the surgeon's trustworthiness (4.3±0.8 vs. 4.0±0.9, P=0.04).Surgeon use of the BC/WC communication framework was not universally preferred but was as acceptable to patients as the traditional R/B framework and rated higher in certain aspects of communication. A preference for a surgeon using BC/WC was associated with lower trust in the medical profession. Surgeons should consider the BC/WC framework to individualize their approach to challenging clinical discussions.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.