Department of Neurology, University of Rochester, Rochester, NY, United States.
Department of Neurology, University of Rochester, Rochester, NY, United States.
Handb Clin Neurol. 2022;190:175-193. doi: 10.1016/B978-0-323-85029-2.00003-8.
Prognosticating is central to primary palliative care in neurology. Many neurologic diseases carry a high burden of troubling symptoms, and many individuals consider health states due to neurologic disease worse than death. Many patients and families report high levels of need for information at all disease stages, including information about prognosis. There are many barriers to communicating prognosis including prognostic uncertainty, lack of training and experience, fear of destroying hope, and not enough time. Developing the right mindset, tools, and skills can improve one's ability to formulate and communicate prognosis. Prognosticating is subject to many biases which can dramatically affect the quality of patient care; it is important for providers to recognize and reduce them. Patients and surrogates often do not hear what they are told, and even when they hear correctly, they form their own opinions. With practice and self-reflection, one can improve their prognostic skills, help patients and families create honest roadmaps of the future, and deliver high-quality person-centered care.
预后是神经病学中初级姑息治疗的核心。许多神经疾病都带来了严重的症状负担，许多人认为由于神经疾病导致的健康状况比死亡更糟糕。许多患者和家属在所有疾病阶段都报告说需要大量信息，包括预后信息。沟通预后存在许多障碍，包括预后不确定性、缺乏培训和经验、担心破坏希望以及时间不足。培养正确的思维模式、工具和技能可以提高制定和沟通预后的能力。预后受到许多偏见的影响，这些偏见会极大地影响患者的护理质量；提供预后信息的医生应该认识到这些偏见并加以减少。患者和代理人经常没有听到他们被告知的内容，即使他们听到了正确的信息，他们也会形成自己的意见。通过实践和自我反思，人们可以提高他们的预后技能，帮助患者和家属为未来制定诚实的路线图，并提供高质量的以患者为中心的护理。
