Department of Surgery, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA.
Ann Palliat Med. 2022 Feb;11(2):958-968. doi: 10.21037/apm-20-2590. Epub 2022 Jan 10.
Surgeons are frequently consulted for assistance in the palliative management of patients, and surgery is an essential tool in the armamentarium of comprehensive palliative care. Palliative surgical consults are some of the most challenging surgical consults, not only for technical reasons, but also because of the (usually) higher odds of morbidity or mortality, often in the setting of a limited life expectancy. Surgery is also often seen as the last possibility of hope, which can place a great emotional burden on the surgeon. Surgeons find themselves torn between concern about causing more harm than good, and not wanting to miss an opportunity to help. Although there is a growing body of literature around the outcomes for palliative surgery and patient selection, most palliative surgery decisions are still not evidence-based, but rather experienced-based. Because palliative surgical decision-making relies heavily on the surgeon's experience and risk (and/or regret) tolerance, surgeons often find themselves called upon to explain highly complex and nuanced concepts with existential outcomes to people who are desperate for hope. Even for the best communicators, achieving the goals of effective communication can be challenging in these situations, and in some instances, may seem unachievable. This article examines the communication challenges faced by surgeons in the palliative surgical setting and recommends specific strategies and approaches to help address those challenges and facilitate effective communication. Lastly, it considers the most necessary element of care for most patients and surgeons in the palliative setting: hope.
外科医生经常被咨询以协助姑息治疗患者，手术是综合姑息治疗武器库中的重要工具。姑息性外科会诊是最具挑战性的外科会诊之一，不仅因为技术原因，还因为发病率或死亡率（通常）更高，而且往往在预期寿命有限的情况下。手术通常也被视为希望的最后可能性，这可能会给外科医生带来巨大的情感负担。外科医生发现自己在担心造成更多伤害而不是好处和不想错过帮助的机会之间左右为难。尽管围绕姑息性手术的结果和患者选择有越来越多的文献，但大多数姑息性手术决策仍然不是基于证据，而是基于经验。由于姑息性手术决策在很大程度上取决于外科医生的经验和风险（和/或遗憾）承受能力，外科医生经常发现自己需要向那些渴望希望的人解释具有存在结果的高度复杂和细微差别的概念。即使对于最好的沟通者来说，在这些情况下实现有效沟通的目标也可能具有挑战性，在某些情况下，似乎是无法实现的。本文探讨了外科医生在姑息性外科环境中面临的沟通挑战，并推荐了具体的策略和方法来帮助解决这些挑战并促进有效的沟通。最后，它考虑了姑息治疗环境中大多数患者和外科医生最需要的护理要素：希望。
