The Challenge of Perioperative Advance Care Planning
The Challenge of Perioperative Advance Care Planning
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DOI：
10.1016/j.jpainsymman.2019.04.023
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发表时间：
2019-09-01
影响因子：
4.7
通讯作者：
Auret, Kirsten
中科院分区：
文献类型：
--
作者：
Ramachenderan, Jonathan;Auret, Kirsten
随着人口老龄化，将有越来越多的患者患有限制生命的疾病，他们可能会被转介进行重大的择期手术，更紧迫的是，他们可能会出现急症，需要重大的紧急手术干预。由于这类患者围手术期和术后并发症的风险很高，因此在急性期手术前明确包含患者护理和复苏状态目标的具体提前护理计划是至关重要的。通过这样做，这将为有限轨迹的患者带来更好的生活质量，并允许就他们的医疗保健做出更明智的决定。此外，这将有助于防止不尊重患者意愿和临床状况的徒劳和不适当的治疗。在这个案例的讨论中，我们探讨了有关限制生命的疾病患者围手术期提前护理计划的挑战的关键主题，并提供了一个框架来帮助指导这一关键时期的对话。(C)2019年美国临终关怀与姑息医学学会。爱思唯尔公司出版，版权所有。
As our population ages, there will be an increasing number of patients with life-limiting disease who may be referred for major elective surgery and more pressingly may present acutely, requiring major emergency surgical intervention. Owing to the high risk of perioperative and postoperative complications associated this group of patients, it is paramount that specific advance care planning that encompasses a patient's goals of care and resuscitative status be clarified before undergoing surgery in this acute period. In doing so, this will lead to a better quality of life for patients with a limited trajectory and allow for more informed decisions to be made about their health care. Furthermore, it will help to prevent futile and inappropriate treatments that do not respect a patient's wishes and their clinical status. In this case discussion, we explore the key themes about the challenge of perioperative advance care planning for patients with life-limiting disease and provide a framework to help guide conversation in this crucial period. (C) 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.