Department of Psychiatry, Laval University and Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec, Canada.
Palliat Support Care. 2012 Sep;10(3):205-11. doi: 10.1017/S1478951511000885.
This article emphasizes the shifting paradigm of palliative care from cancer patients to vital organ failure in chronic diseases. It offers a view about a type of palliative care for patients reaching the pre-terminal phase of a chronic illness. Unlike cancer patients, time is not as sharply delineated and physical pain is not a major factor, but psychological distress is often a major component of the clinical condition. Starting from the perspective of a psychiatric consultant on medical and surgical wards, I present short clinical vignettes to introduce a discussion about psychological manifestations in patients with chronic vital organ failure. The objective is to help patients find meaning to the last stage of their life. To that effect, four key sensitive areas are presented for clinicians to assess end-of-life coping: pressure on character organization, the management of hope, mourning problems, and ill health as a screen for psychological distress.
本文强调了缓和医疗的范式转变，从癌症患者扩展到慢性疾病中的重要器官衰竭。它提供了一种观点，即对于处于慢性疾病终末期的患者的一种缓和医疗。与癌症患者不同，时间的界定不那么明确，身体疼痛不是主要因素，但心理困扰往往是临床状况的一个主要组成部分。从内科和外科病房的精神科顾问的角度出发，我呈现了一些简短的临床案例，以介绍对慢性重要器官衰竭患者的心理表现的讨论。目的是帮助患者在生命的最后阶段找到意义。为此，提出了四个关键的敏感领域，供临床医生评估临终应对：对性格组织的压力、希望的管理、哀悼问题以及健康不良作为心理困扰的一个筛查。
