Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany.
Curr Opin Support Palliat Care. 2012 Sep;6(3):355-64. doi: 10.1097/SPC.0b013e328356ab72.
The purpose of this review is to give an overview of challenges that have been addressed in recent research in end-of-life communication.
Diversity of difficulties that may occur in communication about end-of-life issues has been showed. The emotional quality of this communication requires special skills from professionals involved. Studies showed that physicians and medical students are often overstrained and avoid end-of-life discussions. Health professionals and patients are often ambivalent about end-of-life discussions. Nevertheless, professionals are expected to initiate these in an honest, needs-oriented way. Patient preferences are difficult to infer and have to be assessed explicitly and regularly. Studies showed that the emotional impact of end-of-life discussions can lead to a high burden or avoidance of professionals. Interdisciplinary, multi-professional work can support health professionals in end-of-life care but often structural barriers obstruct possible benefits.
Health professionals need to initiate end-of-life communication in a sensitive way. Specific demands for health professionals in end-of-life communication are to differentiate own emotions and life events from those of patients and to deal with both adequately. Moreover, structural aspects can lead to difficulties between different specialties, professions and sectors, which can have a negative impact on adequate care for patient and relatives. Special efforts for improvement are needed.
本文旨在概述最近关于生命末期沟通的研究中所涉及的挑战。
已表明在涉及生命末期问题的沟通中可能出现的各种困难。这种沟通的情感质量需要涉及的专业人员具备特殊技能。研究表明，医生和医学生经常过度劳累，避免进行生命末期讨论。卫生专业人员和患者通常对生命末期讨论持矛盾态度。然而，专业人员应该以诚实、以需求为导向的方式发起这些讨论。患者的偏好难以推断，必须明确和定期评估。研究表明，生命末期讨论的情感影响可能导致专业人员负担过重或回避。跨学科、多专业的工作可以支持卫生专业人员进行生命末期护理，但通常结构障碍会阻碍可能的利益。
卫生专业人员需要以敏感的方式启动生命末期沟通。生命末期沟通对卫生专业人员的具体要求是区分自己的情绪和生活事件与患者的情绪和生活事件，并妥善处理两者。此外，结构方面可能导致不同专业、职业和部门之间出现困难，从而对患者和亲属的适当护理产生负面影响。需要做出特殊努力加以改善。
