Perspectives on care at the close of life. Initiating end-of-life discussions with seriously ill patients: addressing the "elephant in the room".
Perspectives on care at the close of life. Initiating end-of-life discussions with seriously ill patients: addressing the "elephant in the room".
复制标题
对临终关怀的看法。
DOI：
10.1001/jama.284.19.2502
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
T. Quill
中科院分区：
文献类型：
--
作者：
T. Quill
关于临终问题的讨论对临床医生来说很难发起。患者、家属和临床医生经常串通起来，避免提及死亡或濒死，即使患者的痛苦是严重的，预后很差。除了从观察性研究中确定沟通问题存在的时间和地点外，还可以从与共同面临这些问题的患者、家属和医生的深入讨论中学到很多东西。本文通过对一位晚期肺纤维化患者、他的儿子和他的初级保健医生的采访片段，阐述并探讨了一些沟通问题，包括谁、什么、何时、为什么和如何进行临终讨论。对医学文献的研究、病人和医生的特殊经验以及作者的临床经验为如何解决这些问题提供了实用的见解。更早、更系统地开始临终讨论，可以让患者做出更明智的选择，更好地缓解症状，并有更多机会处理生命结束的问题。《美国医学协会杂志》上。2000; 284:2502 - 2507。
Discussions about end-of-life issues are difficult for clinicians to initiate. Patients, their families, and clinicians frequently collude to avoid mentioning death or dying, even when the patient's suffering is severe and prognosis is poor. In addition to determining from observational research when and where communication problems exist, much can be learned from in-depth discussions with patients, family members, and physicians who are facing these issues together. Using segments of interviews with a patient with advanced pulmonary fibrosis, his son, and his primary care physician, this article illustrates and explores some of these communication issues, including the who, what, when, why, and how of end-of-life discussions. Studies from the medical literature, the patient's and physician's particular experience together, and the author's clinical experience provide practical insights into how to address these issues. Initiating end-of-life discussions earlier and more systematically could allow patients to make more informed choices, achieve better palliation of symptoms, and have more opportunity to work on issues of life closure. JAMA. 2000;284:2502-2507.
家里来了一位新医生：住院系统中的道德问题。
DOI：
10.1001/jama.282.2.171
发表时间：
1999
期刊：
JAMA
影响因子：
--
作者：
Pantilat,SZ;Alpers,A;Wachter,RM
通讯作者：
Wachter,RM