Department of Neurology, University of California San Francisco, San Francisco, California.
Department of Neurology, University of Washington, Seattle, Washington.
Semin Neurol. 2021 Oct;41(5):619-630. doi: 10.1055/s-0041-1731071. Epub 2021 Oct 7.
The palliative care needs of inpatients with neurologic illness are varied, depending on diagnosis, acuity of illness, available treatment options, prognosis, and goals of care. Inpatient neurologists ought to be proficient at providing primary palliative care and effective at determining when palliative care consultants are needed. In the acute setting, palliative care should be integrated with lifesaving treatments using a framework of determining goals of care, thoughtfully prognosticating, and engaging in shared decision-making. This framework remains important when aggressive treatments are not desired or not available, or when patients are admitted to the hospital for conditions related to advanced stages of chronic neurologic disease. Because prognostic uncertainty characterizes much of neurology, inpatient neurologists must develop communication strategies that account for uncertainty while supporting shared decision-making and allowing patients and families to preserve hope. In this article, we illustrate the approach to palliative care in inpatient neurology.
神经疾病住院患者的舒缓治疗需求因诊断、疾病严重程度、可用治疗选择、预后和治疗目标而异。住院神经科医生应该熟练掌握提供初级舒缓治疗的方法，并能够有效地确定何时需要舒缓治疗顾问。在急性情况下，应该使用确定治疗目标、深思熟虑地预测和进行共同决策的框架，将舒缓治疗与救生治疗相结合。当不希望或无法进行积极治疗，或当患者因慢性神经疾病晚期相关疾病入院时，该框架仍然很重要。由于神经科的预后不确定性很大，住院神经科医生必须制定沟通策略，在支持共同决策和允许患者和家属保持希望的同时，考虑到不确定性。在本文中，我们举例说明了住院神经科的舒缓治疗方法。
