Murakami K, Haga T
Dept. of Surgery, Tokyo National Chest Hospital.
Gan To Kagaku Ryoho. 1989 Apr;16(4 Pt 1):740-5.
The decision of treatment for cancer patient in terminal stage differs from that of patients in early stage or in stage of good P.S. (performance status). The small part of patients desire to make every effort for life-prolongation if it follows severe complications, but major part of patients desire to relief from several pains and distresses, or to maintain high quality of life and living. True and enough informations are necessary for patient to choose or decide the course of treatment. The self-decision for treatment by informed consent is desirable. The three points of terminal care are follows: 1) Life-prolonging treatment Life-prolonging treatments with less distress and complication, if that is based on informed consent, are usefull and necessary. 2) Relief for pains and distresses Pain control and aids for psycho-social-religious distresses. 3) Support for the death of desirable choice How to die is how to live. The treatment based on patient's view of life must be chosen. (A) Pre-terminal stage To keep balance the wills for social life and/or life-work and complications of treatment. (B) Final stage The decision of choice of resuscitation and/or intensive care must be decided by patient and/or family.
晚期癌症患者的治疗决策与早期患者或体能状态(PS)良好阶段的患者不同。如果会引发严重并发症,只有一小部分患者希望竭尽全力延长生命,但大部分患者希望缓解各种疼痛和不适,或维持高质量的生活。患者需要真实且足够的信息来选择或决定治疗方案。通过知情同意进行自主治疗决策是可取的。临终关怀有三点:1)延长生命的治疗 如果基于知情同意,采用痛苦和并发症较少的延长生命治疗是有用且必要的。2)缓解疼痛和不适 控制疼痛并帮助缓解心理 - 社会 - 宗教方面的困扰。3)支持理想选择的死亡 如何死亡即如何生活。必须选择基于患者人生观的治疗方式。(A)终末期前阶段 平衡社交生活和/或工作意愿与治疗并发症。(B)最后阶段 复苏和/或重症监护的选择决策必须由患者和/或家属做出。