Service de Médicine Interne, Hôpital Cantonal Fribourg, Fribourg.
Universitäres Zentrum für Palliative Care, Inselspital, Universitätsspital Bern, Bern.
Praxis (Bern 1994). 2021 Nov;110(15):914-924. doi: 10.1024/1661-8157/a003785.
Uncertainty, fear to harm the patient, discomfort handling the discussion and lack of time are the most cited barriers to prognostic disclosure. Physicians can be reassured that patients desire the truth about prognosis and can manage the discussion without harm, including the uncertainty of the information, if approached in a sensitive manner. Conversational guides could provide support in preparing such difficult conversations. Communicating 'with realism and hope' is possible, and anxiety is normal for both patients and clinicians during prognostic disclosure. As a clinician pointed out: 'I had asked a mentor once if it ever got easier. - No. But you get better at it.'
不确定性、害怕伤害患者、处理讨论时感到不适以及缺乏时间，是阻碍预后告知的最常见因素。医生可以放心，患者希望了解真实的预后情况，如果以敏感的方式进行，他们可以在不造成伤害的情况下（包括信息的不确定性）管理好讨论。对话指南可以为准备此类困难对话提供支持。以“现实和希望”的方式进行沟通是可能的，在预后告知过程中，患者和临床医生都会感到焦虑，这是正常的。正如一位临床医生所指出的：“我曾经问过一位导师，预后告知是否会变得更容易。- 不会。但你会做得更好。”
