Rodgers Phillip E
University of Michigan - University Hospital South, F7890 UH South 1500 E. Medical Center Dr SPC 5233, Ann Arbor, MI 48109-5233.
FP Essent. 2020 Nov;498:21-25.
Because of their longstanding relationships with patients, family physicians often are in the best position to identify signs of serious illness progression, provide support and guidance to patients and caregivers, and tailor care plans to individual needs and preferences at the end of life. Significant signs of illness progression include worsening of one or more conditions, decline in function, and increase in the number of emergency department visits or hospitalizations. Prognostication refers to estimation of the remaining life expectancy. Several tools are available to inform such estimates. Prognostication should include discussion of the expected illness progression to help patients and family members prepare, plan, and cope. Advance care planning, ideally started before or early in the course of illness, should include identification of patient surrogate decision-makers as well as a discussion of patient values, priorities, and care preferences. Planning should continue and evolve to inform care plans that match patient and family member priorities at each stage of illness. Family physicians should be familiar with resources available in their communities to support care plans, including palliative care subspecialists, home- and facility-based palliative care teams, and hospice physicians.
由于家庭医生与患者有着长期的关系，他们通常最有能力识别严重疾病进展的迹象，为患者及护理人员提供支持与指导，并在生命末期根据个人需求和偏好制定护理计划。疾病进展的显著迹象包括一种或多种病情恶化、功能衰退以及急诊就诊或住院次数增加。预后评估是指对剩余预期寿命的估计。有几种工具可用于进行此类评估。预后评估应包括对预期疾病进展的讨论，以帮助患者和家庭成员做好准备、制定计划并应对。预先护理计划，理想情况下应在疾病过程开始之前或早期启动，应包括确定患者的替代决策者，以及讨论患者的价值观、优先事项和护理偏好。计划应持续进行并不断发展，以制定与疾病各阶段患者和家庭成员优先事项相匹配的护理计划。家庭医生应熟悉所在社区可用于支持护理计划的资源，包括姑息治疗专科医生、基于家庭和机构的姑息治疗团队以及临终关怀医生。
