Dempsey Ariel, Mulder John
Faculty of Theology and Religion, University of Oxford, Oxford, United Kingdom.
Department of Family Medicine, Division of Palliative Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA; Trillium Institute, Spring Lake, Michigan, USA.
Palliat Med Rep. 2023 Jan 19;4(1):17-23. doi: 10.1089/pmr.2022.0058. eCollection 2023.
A restrictive and dichotomous question has become the primary approach in many goals of care discussions. Is the primary goal of care of life through aggressive therapy or of life through comfort care and hospice? Even though many health care providers recognize that quality vs quantity of life (QvQ) is a false dichotomy, in practice QvQ underlies many goals of care discussions and can negatively impact patient care. This article offers strategies for assessing patients at the end of life, presenting a first-line conversation process that can support a range of treatment options as well as a diversity of dynamic patient values. Based on decades of experience in palliative care and a review of relevant literature, we recommend four practical questions to serve as values "vital signs," monitoring dynamic notions of quality of life and harmonizing patient values with treatment options.
一个具有局限性且二分法的问题已成为许多医疗照护目标讨论中的主要方式。医疗照护的主要目标是通过积极治疗维持生命，还是通过舒适护理和临终关怀维持生命？尽管许多医疗服务提供者认识到生活质量与数量（QvQ）是一种错误的二分法，但在实践中，QvQ是许多医疗照护目标讨论的基础，并且可能对患者护理产生负面影响。本文提供了评估临终患者的策略，介绍了一个一线对话流程，该流程可以支持一系列治疗选择以及患者多样的动态价值观。基于在姑息治疗方面数十年的经验以及对相关文献的回顾，我们推荐四个实用问题作为价值观“生命体征”，以监测生活质量的动态观念，并使患者价值观与治疗选择相协调。
