Casarett David J, Quill Timothy E
Center for Health Equity Research and Promotion at the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Ann Intern Med. 2007 Mar 20;146(6):443-9. doi: 10.7326/0003-4819-146-6-200703200-00011.
Hospice programs offer unique benefits for patients who are near the end of life and their families, and growing evidence indicates that hospice can provide high-quality care. Despite these benefits, many patients do not enroll in hospice, and those who enroll generally do so very late in the course of their illness. Some barriers to hospice referral arise from the requirements of hospice eligibility, which will be difficult to eliminate without major changes to hospice organization and financing. However, the challenges of discussing hospice create other barriers that are more easily remedied. The biggest communication barrier is that physicians are often unsure of how to talk with patients clearly and directly about their poor prognosis and limited treatment options (both requirements of hospice referral) without depriving them of hope. This article describes a structured strategy for discussing hospice, based on techniques of effective communication that physicians use in other "bad news" situations. This strategy can make hospice discussions both more compassionate and more effective.
临终关怀项目为临终患者及其家人提供了独特的益处，越来越多的证据表明临终关怀能够提供高质量的护理。尽管有这些益处，但许多患者并未加入临终关怀项目，而那些加入的患者通常也是在病程晚期才这样做。临终关怀转诊存在一些障碍，部分源于临终关怀资格的要求，如果不对临终关怀组织和资金投入进行重大改革，这些障碍将难以消除。然而，讨论临终关怀所面临的挑战还造成了其他更容易解决的障碍。最大的沟通障碍是，医生常常不确定如何在不剥夺患者希望的情况下，清晰、直接地与患者谈论其预后不良和有限的治疗选择（这两者都是临终关怀转诊的要求）。本文介绍了一种基于医生在其他“坏消息”情况下所使用的有效沟通技巧来讨论临终关怀的结构化策略。这种策略能够使临终关怀的讨论更具同情心且更有效。
