Temmy Latner Centre for Palliative Care and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 60 Murray Street, 4th Floor, Box 13, Toronto, Ontario, M5T 3L9, Canada; Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Canada; Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Patient Educ Couns. 2019 Aug;102(8):1570-1572. doi: 10.1016/j.pec.2019.03.012. Epub 2019 Mar 28.
During the course of recruitment for a randomized control trial, the author encounters a patient who changes her perspective on research and who inspires her to continue work in the field of palliative care. The author describes this encounter and her reflections regarding it using quotations from the patient's presurgical consent visit for major surgery with his surgeon and wife. The author explores the layers of complexity in the preoperative visit--the patient's changing medical condition, patient-companion relationship, and patient-provider relationship--that lead to a reconsideration of whether to proceed with surgery. Advance care planning and goals of care are explored unexpectedly, wherein the patient must weigh surgical risks with quality of life considerations. The piece's focus on shared decision making towards end of life reinforces the value of discussing these topics before major surgery and in complicated cases.
在一项随机对照试验的招募过程中，作者遇到了一位改变了她对研究看法的患者，这激励她继续从事姑息治疗领域的工作。作者使用患者在接受外科医生及其妻子进行大手术前同意书时的引语，描述了这次相遇以及她对此的反思。作者探讨了术前访视中的复杂层面——患者不断变化的身体状况、患者与同伴的关系以及患者与提供者的关系——这些层面导致了对是否进行手术的重新考虑。在术前访视中，还探讨了预先护理计划和护理目标，患者必须权衡手术风险与生活质量的考虑。这篇文章的重点是在生命末期进行共同决策，强调了在进行重大手术前以及在复杂病例中讨论这些话题的重要性。
