Crighton Margaret H, Coyne Bridget M, Tate Judith, Swigart Valerie, Happ Mary Beth
School of Nursing, University of Pittsburgh, Pennsylvania 15261, USA.
Cancer Nurs. 2008 Nov-Dec;31(6):478-84. doi: 10.1097/01.NCC.0000339257.14066.d5.
Traditionally, the intensive care unit (ICU) has focused on reversal of life-threatening illness. Patients with incurable cancer admitted to the ICU present unique challenges for clinicians when these patients transition to end-of-life (EOL) care. A dimensional analysis of a single case study from a larger 30-case ethnographic study was used to explore the cancer patient's transition to EOL care in the ICU. Family members and clinicians had different expectations of care, which resulted in divergent treatment goals and desires for the patient, a 62-year-old woman with presumed pneumonia and underlying terminal glioblastoma multiforme. The attending physician and palliative care consultant unified family members' and clinicians' divergent goals and desires through a mediating process of probing the family about the patient's wishes. This process unified those involved and brought them to a place of acceptance. This case illustrates the turning point and rationale for the shift to EOL care in the ICU and the important role that communication plays in the transition. Understanding individual and family processes and family members' need for time to adjust to the transition to EOL is an essential element of practice within ICUs that increasingly manage terminally ill cancer patients.
传统上，重症监护病房（ICU）一直专注于逆转危及生命的疾病。入住ICU的晚期癌症患者在向临终（EOL）护理过渡时给临床医生带来了独特的挑战。本研究从一项包含30个案例的大型人种学研究中选取了一个案例进行维度分析，以探讨癌症患者在ICU中向EOL护理的过渡情况。家庭成员和临床医生对护理的期望不同，这导致了对一名62岁女性患者的治疗目标和愿望产生分歧，该患者被诊断为疑似肺炎且患有晚期多形性胶质母细胞瘤。主治医生和姑息治疗顾问通过询问家属患者意愿的调解过程，统一了家庭成员和临床医生不同的目标和愿望。这一过程使相关各方达成一致，并使他们能够接受现实。该案例说明了在ICU中转向EOL护理的转折点和基本原理，以及沟通在这一过渡过程中所起的重要作用。了解个体和家庭过程以及家庭成员适应向EOL过渡所需的时间，是越来越多地收治晚期癌症患者的ICU临床实践的一个基本要素。
