Carron A T, Lynn J, Keaney P
George Washington University, Washington, DC 20037, USA.
Ann Intern Med. 1999 Jan 5;130(1):82-6. doi: 10.7326/0003-4819-130-1-199901050-00037.
Improvement in end-of-life care has become a demand of the public and a priority for health care professionals. Medical textbooks could support this improvement by functioning as educational resources and as reference material. In this paper, four widely used general medical textbooks are assessed for their coverage of nine content domains for 12 illnesses that often cause death; each domain in each disease and in each text was graded for presence and helpfulness of advice. Helpful information was rare, and only prognostication and medical treatments to alter the course of the disease were usually mentioned. Harrison's Textbook of Medicine, The Merck Manual, and Scientific American Medicine often mentioned at least a few of the domains in each disease, although not often in a way that would guide a clinician. Manual of Medical Therapeutics (The Washington Manual) includes little information about end-of-life care. Improvement seems possible. Short additions of information on end-of-life care would probably be effective. Many chapters discussed at length certain topics that are clearly optional; other textbooks addressed these topics only briefly. When dealing with end-of-life care, physicians should seek guidance from other sources and textbook authors and editors should improve the utility and completeness of their texts.
临终关怀的改善已成为公众的需求以及医疗保健专业人员的优先事项。医学教科书可作为教育资源和参考资料，从而支持这一改善。本文评估了四本广泛使用的普通医学教科书对12种常导致死亡疾病的九个内容领域的涵盖情况；对每种疾病和每篇文本中的每个领域，根据建议的存在情况和实用性进行评分。有用的信息很少，通常只提及预后和改变疾病进程的医疗治疗方法。《哈里森内科学》《默克诊疗手册》和《科学美国人医学》通常在每种疾病中至少提及一些领域，尽管方式通常不足以指导临床医生。《医学治疗手册》（《华盛顿手册》）包含的临终关怀信息很少。改善似乎是可能的。简短增加临终关怀信息可能会有效。许多章节详细讨论了某些显然可选择的主题；其他教科书只是简要提及了这些主题。在处理临终关怀时，医生应从其他来源寻求指导，教科书作者和编辑应提高其文本的实用性和完整性。
