Berlin Ana
Department of Surgery, Rutgers New Jersey Medical School, Medical Science Building G-506, 185 South Orange Avenue, Newark, NJ 07103, USA.
Surg Clin North Am. 2017 Dec;97(6):1275-1290. doi: 10.1016/j.suc.2017.07.005. Epub 2017 Oct 5.
Despite advances in surgical critical care, critical illness remains traumatic and has long-term adverse sequelae. Unrealistic expectations and erroneous assumptions about outcomes acceptable to patients have been identified as drivers of goal-discordant treatment. Goal setting in the ICU begins with compassionately delivered, accurate, and honest prognostic information. Through skilled communication and shared decision making, clinicians forge a mutual understanding of patient values and priorities and the role of therapeutic options in achieving patient goals. Ensuring that treatment is goal-concordant and meets physical, psychosocial, existential, and spiritual needs is crucial for attaining optimal patient and caregiver outcomes, independent of survival.
尽管外科重症监护取得了进展，但危重病仍然具有创伤性，并会产生长期不良后遗症。对患者可接受结果的不切实际期望和错误假设已被确定为目标不一致治疗的驱动因素。重症监护病房（ICU）的目标设定始于富有同情心地提供准确和诚实的预后信息。通过熟练的沟通和共同决策，临床医生对患者的价值观和优先事项以及治疗选择在实现患者目标中的作用达成相互理解。确保治疗与目标一致并满足身体、心理社会、生存和精神需求，对于实现最佳的患者和护理人员结局至关重要，而与生存无关。
