Cifrese Laura, Rincon Fred
Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Semin Neurol. 2018 Oct;38(5):561-568. doi: 10.1055/s-0038-1667386. Epub 2018 Oct 15.
As medical decisions fall under more scrutiny and society demands increasing transparency of care, it is likely that more opportunities for conflicts will emerge. Similarly, with increasing demand and a static supply, the issue of who receives treatment and for how long naturally will arise. This mismatch leads to discussions of resource utilization and limitation of care in light of patients' values and rights. Clinicians should always be forthcoming with the uncertainty of prognostication while also articulating the severity of a patient's disease in relation to the risk and benefits of an intervention. However, dispute over treatment course and the idea of futile care can arise for in a variety of reasons, both from the clinician and the patient. Without identifying the cause of these conflicts, it is impossible to have effective communication. At times, it is important to utilize various negotiating skills when resolving these disagreements. Regardless of the approach, practitioners need more training in and exposure to these types of conflicts. In this review, we provide a framework for the origins and current state of futility, challenges in the application of the term, and recommendations on how to approach conflict in these situations.
随着医疗决策受到更多审查，且社会要求医疗护理具有更高的透明度，可能会出现更多冲突的机会。同样，随着需求增加而供应保持不变，谁接受治疗以及治疗多长时间的问题自然会出现。这种不匹配导致了根据患者的价值观和权利对资源利用和护理限制的讨论。临床医生应该始终坦率地说明预后的不确定性，同时也要阐明患者疾病的严重程度与干预措施的风险和益处的关系。然而，关于治疗过程的争议以及无效治疗的观念可能由于各种原因而出现，这些原因既来自临床医生，也来自患者。如果不找出这些冲突的原因，就不可能进行有效的沟通。有时，在解决这些分歧时运用各种谈判技巧很重要。无论采用何种方法，从业者都需要更多关于这类冲突的培训和接触。在这篇综述中，我们提供了一个关于无效治疗的起源和现状、该术语应用中的挑战以及在这些情况下如何处理冲突的建议的框架。
