Kalsi Dilraj, Ward Joel, Lee Regent, Wee Bee, Fulford Kenneth Wm, Handa Ashok
Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
Dilraj Kalsi and Joel Ward are joint first authors.
J Patient Exp. 2020 Aug;7(4):621-628. doi: 10.1177/2374373519869153. Epub 2019 Sep 12.
Recognizing dying patients is crucial to produce outcomes that are satisfactory to patients, their families, and clinicians.
Earlier discussion of and shared decision-making around dying to improve these outcomes.
In this study, we interviewed 16 senior clinicians to develop summaries of palliative care in 4 key specialties: Cardiology, Vascular Surgery, Emergency General Surgery, and Intensive Care.
Oxford University Hospitals.
Based on themes common to our 4 clinical areas, we developed a novel diagnostic framework to support shared palliative decision-making that can be summarized as follows: 1) Is the acute pathology reversible? 2) What is the patient's physiological reserve? 3) What is important to the patient? Will they be fit enough for discharge for a reasonable length of time?
We believe that education using this framework in the medical school and postgraduate curricula would significantly improve recognition of dying patients. This would serve to stimulate earlier conversations, more shared decision-making, and ultimately better outcomes in palliative care and patient experience.
识别临终患者对于产生让患者、其家属及临床医生都满意的结果至关重要。
更早地围绕临终进行讨论并共同决策，以改善这些结果。
在本研究中，我们采访了16位资深临床医生，以制定4个关键专科（心脏病学、血管外科、普通急诊外科和重症监护）的姑息治疗总结。
牛津大学医院。
基于我们4个临床领域共有的主题，我们开发了一个新颖的诊断框架，以支持共同的姑息治疗决策，可总结如下：1）急性病变是否可逆？2）患者的生理储备如何？3）对患者来说什么是重要的？他们是否足够健康以出院一段合理的时间？
我们认为，在医学院校和研究生课程中使用此框架进行教育将显著提高对临终患者的识别。这将有助于激发更早的对话、更多的共同决策，并最终在姑息治疗和患者体验方面取得更好的结果。
