Department of Anesthesiology and Perioperative Medicine, 160343Augusta University, Augusta, GA, USA.
Am J Hosp Palliat Care. 2021 Sep;38(9):1064-1070. doi: 10.1177/1049909120969970. Epub 2020 Oct 29.
End of life discussions frequently take place in surgical intensive care units, as a significant number of patients die while admitted to the hospital, and surgery is common during the last month of life. Multiple barriers exist to the initiation of these conversations, including: miscommunication between clinicians and surrogates, a paternalistic approach to surgical patients, and perhaps, conflicts of interest as an unwanted consequence of surgical quality reporting. Goal discordant care refers to the care that is provided to a patient that is incapacitated and that is not concordant to his/her wishes. This is a largely unrecognized medical error with devastating consequences, including inappropriate prolongation of life and non-beneficial therapy utilization. Importantly, hospice and palliative care needs to be recognized as quality care in order to deter the incentives that might persuade clinicians from offering these services.
生命末期讨论经常在外科重症监护病房进行，因为大量患者在住院期间死亡，而手术在生命的最后一个月很常见。这些对话的发起存在多种障碍，包括：临床医生和代理人之间的沟通不畅、对手术患者的家长式作风以及手术质量报告的潜在利益冲突。目标不一致的医疗照护是指为无法表达意愿的患者提供的不符合其意愿的医疗照护。这是一种很大程度上未被认识到的医疗错误，会带来毁灭性的后果，包括不必要地延长生命和非有益治疗的使用。重要的是，临终关怀和姑息治疗需要被视为高质量的医疗服务，以阻止可能促使临床医生提供这些服务的激励措施。
