Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Medical Ethics and Humanities Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Philosophy, Northwestern University, Evanston, Illinois, USA.
World Neurosurg. 2022 Dec;168:139-145. doi: 10.1016/j.wneu.2022.10.003. Epub 2022 Oct 7.
Neurosurgical conditions are often incurable and lead to disability, severe physical symptoms, and distress for patients and families. Neurosurgeons may be responsible for transitioning management from curative to palliative. We sought to analyze the ethics of transitioning care from curative to palliative in patients in one's own specialty.
This was a case-based narrative review. PubMed and Google Scholar were searched with no restrictions on date. Studies relevant to the topic were included.
After providing an introductory case, we defined the curative and palliative neurosurgical treatment paradigms, clarified the concept of transition of care from curative to palliative, and contrasted generalist and specialist palliative care. Next, we provided an overview of core ethical principles. We then described key considerations involved in transitioning patients from curative to palliative care in one's own specialty, namely, knowledge, communication, uncertainty, and futility. Finally, we provided an analysis of the introductory case, highlighting the conflict of interest inherent in the transition.
It is acceptable for neurosurgeons and other specialists with adequate palliative care training to manage the transition to palliative care in most cases, preferably as part of multidisciplinary care teams. While we discuss the example of neurosurgery, this analysis applies to other specialties where care transitions from curative to palliative intent occur. Across specialties, patient preferences and values are foundational in the timing and specifics of this transition.
神经外科疾病通常无法治愈，会导致患者及其家庭残疾、出现严重的身体症状和痛苦。神经外科医生可能需要负责将治疗模式从治愈性转为姑息性。我们旨在分析在自身专业领域中对患者进行治疗模式从治愈性向姑息性转变的伦理问题。
这是一项基于案例的叙述性综述。我们对 PubMed 和 Google Scholar 进行了检索，没有对日期进行限制。纳入了与主题相关的研究。
在提供一个介绍性病例后，我们定义了治愈性和姑息性神经外科治疗模式，阐明了从治愈性向姑息性治疗转变的概念，并对比了通科和专科姑息治疗。接下来，我们概述了核心伦理原则。然后，我们描述了在自身专业领域中从治愈性护理向姑息性护理转变的患者所涉及的关键考虑因素，即知识、沟通、不确定性和无效性。最后，我们对介绍性病例进行了分析，强调了在转变过程中固有的利益冲突。
在大多数情况下，接受过充分姑息治疗培训的神经外科医生和其他专科医生可以管理向姑息治疗的转变，最好是作为多学科护理团队的一部分。虽然我们讨论了神经外科的例子，但这种分析适用于其他出现从治愈性意图向姑息性意图转变的治疗模式的专业领域。在各个专业领域中，患者的偏好和价值观是决定这种转变的时机和具体细节的基础。
