Recommendations for Best Communication Practices to Facilitate Goal-concordant Care for Seriously Ill Older Patients With Emergency Surgical Conditions
Recommendations for Best Communication Practices to Facilitate Goal-concordant Care for Seriously Ill Older Patients With Emergency Surgical Conditions
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DOI：
10.1097/sla.0000000000001491
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发表时间：
2016-01-01
影响因子：
9
通讯作者：
Block, Susan D.
中科院分区：
文献类型：
--
作者：
Cooper, Zara;Koritsanszky, Luca A.;Block, Susan D.
目的：探讨改进沟通实践的必要性，以促进外科急诊重症老年患者的目标协调护理。摘要背景数据：改善沟通越来越被认为是提供目标一致的护理和减少重病老年患者的医疗保健利用和成本的核心因素。考虑到生命最后几周的高手术率，这些患者急诊手术后预后不良的高风险，以及急性环境中高质量沟通的障碍，我们试图建立一个框架，以支持外科医生与患有外科急诊的重病老年患者沟通。方法：由23位国家领导人组成的跨学科小组在哈佛医学院召开了为期1天的会议，就沟通框架的概念、内容、格式和可用性提供意见。创建了一个原型框架。结果：参与者支持在这些场景中采用结构化方法进行沟通的概念，并描述了框架的9个关键要素：(1)制定预后，(2)建立个人联系，(3)在潜在疾病的背景下披露有关急性问题的信息，(4)建立对患者病情的共同理解，(5)允许沉默和处理情绪，(6)描述手术和姑息治疗方案，(7)引出患者的目标和优先事项，(8)提出治疗建议，(9)确认对患者和家属的持续支持。结论：急诊重症患者沟通困难。建议的沟通框架可以帮助外科医生为高危患者提供目标一致的护理。
Objective:To address the need for improved communication practices to facilitate goal-concordant care in seriously ill, older patients with surgical emergencies.Summary Background Data:Improved communication is increasingly recognized as a central element in providing goal-concordant care and reducing health care utilization and costs among seriously ill older patients. Given high rates of surgery in the last weeks of life, high risk of poor outcomes after emergency operations in these patients, and barriers to quality communication in the acute setting, we sought to create a framework to support surgeons in communicating with seriously ill, older patients with surgical emergencies.Methods:An interdisciplinary panel of 23 national leaders was convened for a 1-day conference at Harvard Medical School to provide input on concept, content, format, and usability of a communication framework. A prototype framework was created.Results:Participants supported the concept of a structured approach to communication in these scenarios, and delineated 9 key elements of a framework: (1) formulating prognosis, (2) creating a personal connection, (3) disclosing information regarding the acute problem in the context of the underlying illness, (4) establishing a shared understanding of the patient's condition, (5) allowing silence and dealing with emotion, (6) describing surgical and palliative treatment options, (7) eliciting patient's goals and priorities, (8) making a treatment recommendation, and (9) affirming ongoing support for the patient and family.Conclusions:Communication with seriously ill patients in the acute setting is difficult. The proposed communication framework may assist surgeons in delivering goal-concordant care for high-risk patients.