Dalhousie University Faculty of Medicine, Department of Medicine, Halifax, Canada.
Nova Scotia Health Authority, Halifax, Canada.
J Palliat Med. 2024 Oct;27(10):1297-1302. doi: 10.1089/jpm.2024.0076. Epub 2024 Aug 16.
Health care professionals can enhance conversations about serious illness and medical decision-making by adopting a transparent, standardized approach. This article critiques established communication strategies, which often emphasize patient values and goals without providing the necessary medical information to align these goals with a shared understanding of prognosis. We propose an alternate strategy that (1) provides detailed explanations of medical conditions at the beginning of the conversation, (2) includes support persons in discussions, (3) considers capacity, and (4) offers tailored advice by clinicians. The proposed framework aims to provide patients (or their delegates) with the information they need to integrate their values in pursuit of well-informed medical decisions. This strategy builds trust by providing honest information about medical conditions and their trajectories. It empowers decision makers to consider realistic outcomes, allowing them to accept or reject treatments in accordance with their preferences. This article presents a thorough step-by-step guide on how to conduct a serious illness conversation and facilitate medical decision-making, including a supplement that provides example phrases for use in clinical practice.
医疗保健专业人员可以通过采用透明、标准化的方法来增强关于严重疾病和医疗决策的对话。本文批评了现有的沟通策略，这些策略通常强调患者的价值观和目标，但没有提供必要的医疗信息，以使这些目标与对预后的共同理解保持一致。我们提出了一种替代策略，（1）在对话开始时提供详细的医疗状况说明，（2）在讨论中包括支持人员，（3）考虑能力，（4）由临床医生提供量身定制的建议。拟议的框架旨在为患者（或其代理人）提供他们需要的信息，以整合他们的价值观，做出明智的医疗决策。通过提供关于医疗状况及其轨迹的诚实信息，该策略建立了信任。它使决策者能够考虑现实的结果，使他们能够根据自己的喜好接受或拒绝治疗。本文提供了一份关于如何进行严重疾病对话和促进医疗决策的详细逐步指南，包括一份补充材料，其中提供了在临床实践中使用的示例短语。
