School of Social Science, University of Queensland, St. Lucia, QLD 4072, Australia.
Soc Sci Med. 2013 Feb;78:9-16. doi: 10.1016/j.socscimed.2012.11.008. Epub 2012 Nov 15.
Accompanying patients from active treatment towards specialist palliative care is a complex sphere of clinical practice that can be fraught with interpersonal and emotional challenges. While medical specialists are expected to break 'bad news' to their patients and ease their transitions to specialist palliative care if required, few have received formal training in such interpersonal complexities. Furthermore, there also often exists clinical ambiguity around whether to continue active treatment vis-à-vis refocusing on quality of life and palliation. In this paper we explore the experiences of twenty Australian medical specialists, focussing on issues such as: dilemmas around when and how to talk about dying and palliation; the art of referral and practices of representation; and, accounts of emotion and subjective influences on referral. The results illustrate how this transitional realm can be embedded in emotions, relationships and the allure of potentially life-prolonging intervention. We argue that the practice of referral should be understood as a relational and contextually-bound process.
陪伴患者从积极治疗转向专业姑息治疗是临床实践中的一个复杂领域，可能充满人际和情感挑战。虽然医疗专家应该向患者传达“坏消息”，并在需要时帮助他们过渡到专业姑息治疗，但很少有人接受过此类人际复杂性方面的正式培训。此外，在是否继续积极治疗与关注生活质量和姑息治疗之间，还经常存在临床上的模糊性。在本文中，我们探讨了 20 名澳大利亚医学专家的经验，重点关注以下问题：何时以及如何谈论死亡和姑息治疗的困境；转诊的艺术和代表性实践；以及对情感和对转诊的主观影响的描述。研究结果表明，这个过渡领域如何嵌入在情感、关系和潜在的延长生命的干预措施的吸引力中。我们认为，转诊实践应该被理解为一个关系和背景相关的过程。
