Point: Care of potential low-risk basal cell carcinomas (BCCs) at the end of life: The key role of the dermatologist.
Point: Care of potential low-risk basal cell carcinomas (BCCs) at the end of life: The key role of the dermatologist.
复制标题
观点：临终时潜在低风险基底细胞癌 (BCC) 的护理：皮肤科医生的关键作用。
DOI：
10.1016/j.jaad.2015.02.005
复制
发表时间：
2015
影响因子：
13.8
通讯作者：
Chren,Mary-Margaret
中科院分区：
文献类型：
--
作者：
Linos,Eleni;Berger,Timothy;Chren,Mary-Margaret
在生命结束时不必要的医疗保健是一个在许多医学领域都得到充分认识的问题，包括前列腺癌，乳腺癌和择期手术的护理。1-3如果治疗和检查涉及的风险超过潜在的益处，则它们可能是不必要的，甚至是不适当的。例如，鉴于已知的风险和筛查的有限益处，乳房X光检查不再推荐给寿命不到10年的女性。4.为了将服务目标对准那些可能受益的人，许多指南现在建议将预期寿命纳入临床决策。1，4，5作为治疗低风险肿瘤患者的皮肤科医生，如小结节和浅表基底细胞癌（BCC），我们需要考虑我们自己的专业问题。作为临床医生，我们经常面临的一些难题包括：这个病人是否太虚弱而不能转诊到莫氏综合征？我该如何做决定？如果我错了呢？当我的医疗建议与患者或家属的要求不符时，我该怎么办？治疗决策中是否应该考虑成本？我该如何记录这些而不被起诉？
Unnecessary health care at the end of life is a problem well recognized in many areas of medicine including the care of prostate cancer, breast cancer, and elective surgeries. 1–3 Treatments and tests may be unnecessary or even inappropriate if they involve risks that outweigh potential benefits. For example, mammography is no longer recommended in women who have less than 10 years to live, given the known risks and limited benefits of screening. 4 To target services to those who may benefit, many guidelines now recommend incorporating life expectancy into clinical decisions. 1, 4, 5 As dermatologists who care for patients with low-risk tumors, such as small (< 1 cm) nodular and superficial basal cell carcinomas (BCCs), we need to think about this issue for our own specialty.Some difficult questions we often face as clinicians include: Is this patient too frail to be referred for Mohs? How do I make that decisione—and what if I am wrong? What do I do when my medical recommendation does not match what the patient or family wants? Should cost ever be a consideration in treatment decision-making? How do I document this without getting sued?