Palliative medicine and end-of-life care
Palliative medicine and end-of-life care
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DOI：
10.1016/b978-0-12-804766-8.00030-3
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发表时间：
2019-01-01
期刊：
影响因子：
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通讯作者：
Kluger, Benzi M.
中科院分区：
文献类型：
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作者：
Glover, Toni L.;Kluger, Benzi M.
姑息治疗是一种护理受严重疾病影响的患者及其家人的方法，旨在通过管理医学症状，心理问题，精神健康和设定护理目标来减少痛苦。受神经退行性疾病影响的患者和家庭从诊断时开始就有显着的姑息治疗需求，并通过临终关怀和丧亲之痛延伸。我们提倡一种解决这些需求的方法，其中患者的初级保健提供者或神经科医生起着核心作用。为这一人群提供有效姑息治疗的关键技能包括：同情地提供诊断，设定护理目标，预测安全问题，护理人员评估，提前护理计划，解决心理社会问题，及时转诊到临终关怀。管理令人痛苦的医学和精神症状对于改善整个疾病过程以及生命末期的生活质量至关重要。许多症状在疾病中是常见的;然而，有一些问题是最常见的神经退行性疾病类别所特有的，即痴呆症，帕金森症和运动神经元疾病。采用姑息治疗方法，虽然在许多方面具有挑战性，但使医生能够为患者和家属提供更大的支持和指导，帮助他们度过神经退行性疾病的艰难旅程。
Palliative care is an approach to the care of patients, affected by serious illness, and their families that aims to reduce suffering through the management of medical symptoms, psychosocial issues, spiritual wellbeing, and setting goals of care. Patients and families affected by a neurodegenerative illness have significant palliative care needs beginning at the time of diagnosis and extending through end-of-life care and bereavement. We advocate an approach to addressing these needs where the patient's primary care provider or neurologist plays a central role. Key skills in providing effective palliative care to this population include providing the diagnosis with compassion, setting goals of care, anticipating safety concerns, caregiver assessment, advance care planning, addressing psychosocial concerns, and timely referral to a hospice. Managing distressing medical and psychiatric symptoms is critical to improving quality of life throughout the disease course as well as at end-of-life. Many symptoms are common across illnesses; however, there are issues that are specific to the most common classes of neurodegenerative illness, namely dementia, parkinsonism, and motor neuron disease. Incorporating a palliative approach to care, although challenging in many ways, empowers physicians to provide greater support and guidance to patients and families in making the difficult journey through a neurodegenerative illness.