Knies Andrea K, Hwang David Y
Division of Primary Care, Yale School of Nursing, West Haven, Connecticut.
Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, Connecticut.
Semin Neurol. 2016 Dec;36(6):631-641. doi: 10.1055/s-0036-1592358. Epub 2016 Dec 1.
Many neurocritically ill patients and their families have high amounts of palliative care needs. Multiple professional societies relevant to neurocritical care have released consensus statements on meeting palliative care needs in neuroscience intensive care units. In this review, the authors discuss the ongoing debate regarding what model of palliative care delivery is optimal, focus on the process of shared decision making during goals-of-care discussions, and briefly comment on transitions from intensive care to comfort care. Regardless of an institution's model of palliative care practice, every neurocritical care clinician should possess core competencies necessary to provide basic, integrative palliative care for neurocritically ill patients. Given the high proportion of neurocritically ill patients who lack decision-making capacity, communication skills that enable clinicians to facilitate shared decision making with patients' surrogates are of particular relevance, especially when the limitation of life support is in the discussion. High-quality decision aids to assist neurocritical care teams and surrogate decision makers during common goals-of-care discussions may have the potential for further promotion of best palliative care practices.
许多神经重症患者及其家属有大量的姑息治疗需求。多个与神经重症监护相关的专业协会已发布关于在神经科学重症监护病房满足姑息治疗需求的共识声明。在本综述中，作者讨论了关于何种姑息治疗提供模式最为理想的持续争论，聚焦于照护目标讨论期间的共同决策过程，并简要评论从重症监护向舒适护理的过渡。无论机构的姑息治疗实践模式如何，每位神经重症监护临床医生都应具备为神经重症患者提供基本的、综合姑息治疗所需的核心能力。鉴于缺乏决策能力的神经重症患者比例较高，使临床医生能够与患者代理人共同促进决策的沟通技巧尤为重要，特别是在讨论生命支持的限制时。在常见的照护目标讨论中协助神经重症监护团队和替代决策者的高质量决策辅助工具可能有进一步推广最佳姑息治疗实践的潜力。
