Freyer David R, Kuperberg Aura, Sterken David J, Pastyrnak Steven L, Hudson Dan, Richards Tom
Division of Hematology/Oncology/Bone Marrow Transplantation, DeVos Children's Hospital, 100 Michigan NE, Mailcode 85, Grand Rapids, MI 49503, USA.
Child Adolesc Psychiatr Clin N Am. 2006 Jul;15(3):693-715. doi: 10.1016/j.chc.2006.02.003.
The adolescent at the end of life poses a unique combination of challenges resulting from the collision of failing health with a developmental trajectory meant to lead to attainment of personal independence. Because virtually all spheres of the dying adolescent's life are affected, optimal palliative care for these young persons requires a multidisciplinary team whose members have a good understanding of their complementary roles and a shared commitment to providing well-coordinated care. Members of the team include the physician (to initiate and coordinate palliative care management); the nurse (to work collaboratively with the physician and adolescent, especially through effective patient advocacy); the psychologist (to assess and manage the patient's neurocognitive and emotional status); the social worker (to assess and optimize support networks); the chaplain (to support the adolescent's search for spiritual meaning); and the child life specialist (to facilitate effective communication in preparing for death). A crucial area for dying adolescents is medical decision making, where the full range of combined support is needed. By helping the young person continue to develop personal autonomy, the multidisciplinary team will enable even the dying adolescent to experience dignity and personal fulfillment.
处于生命末期的青少年面临着独特的挑战组合，这是由健康状况恶化与旨在实现个人独立的发展轨迹相互冲突所致。由于临终青少年生活的几乎所有方面都会受到影响，因此为这些年轻人提供最佳的姑息治疗需要一个多学科团队，其成员要充分理解各自的互补角色，并共同致力于提供协调良好的护理。团队成员包括医生（发起并协调姑息治疗管理）、护士（与医生和青少年协作，尤其是通过有效的患者权益倡导）、心理学家（评估并管理患者的神经认知和情绪状态）、社会工作者（评估并优化支持网络）、牧师（支持青少年探寻精神意义）以及儿童生活专家（在为死亡做准备时促进有效沟通）。临终青少年的一个关键领域是医疗决策，在此需要全方位的综合支持。通过帮助年轻人持续发展个人自主性，多学科团队将使即便处于临终阶段的青少年也能体验到尊严和个人成就感。
