Gursahani Roop
Department of Neurology, PD Hinduja Hospital, Mumbai, Maharashtra, India.
Ann Indian Acad Neurol. 2016 Oct;19(Suppl 1):S40-S44. doi: 10.4103/0972-2327.192885.
End-of-life care is an integral part of neurology practice, and neuropalliative medicine is an emerging neurology subspeciality. This begins with serious illness communication as a protocol-based process that depends on an evaluation of patient autonomy and accurate prognostication. Communication needs vary between chronic, life-limiting neurologic illnesses and acute brain injury. In an ideal situation, the patient's wishes are spelled out in advance care plans and living wills, and surrogates have only limited choices for implementation. Palliative care prepares for decline and death as an expected outcome and focuses on improving the quality of life for both the patients and their caregivers. In the Intensive Care Unit, this may require clarity on withholding and withdrawal of treatment. In all locations of care, the emphasis is on symptom control. Neurologists are the quintessential physicians, and our "dharma" is best served by empathetically bringing our technical knowledge and communication skills into easing this final transition for our patients and their families to the best of our ability.
临终关怀是神经病学实践的一个组成部分，而神经姑息医学是一个新兴的神经病学亚专业。这始于作为基于协议的过程的重病沟通，该过程依赖于对患者自主性的评估和准确的预后判断。慢性、限制生命的神经系统疾病和急性脑损伤之间的沟通需求有所不同。在理想情况下，患者的意愿会在预先护理计划和生前遗嘱中明确规定，代理人在实施方面的选择有限。姑息治疗将衰退和死亡作为预期结果做好准备，并专注于提高患者及其护理人员的生活质量。在重症监护病房，这可能需要明确治疗的 withhold 和 withdrawal。在所有护理场所，重点都是症状控制。神经科医生是典型的医生，我们的“职责”最好通过富有同理心地带入我们的技术知识和沟通技巧，尽我们所能为患者及其家人轻松度过这最后的转变来履行。
