Perspectives on care at the close of life. Serving patients who may die soon and their families: the role of hospice and other services.
Perspectives on care at the close of life. Serving patients who may die soon and their families: the role of hospice and other services.
复制标题
对临终关怀的看法。
DOI：
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复制
发表时间：
2001
期刊：
影响因子：
--
通讯作者：
J. Lynn
中科院分区：
文献类型：
--
作者：
J. Lynn
一名 47 岁晚期直肠癌男性的案例说明了专业服务和护理系统策略可帮助临床医生为临终患者提供服务。对于了解其预后的患者，初级保健医生的服务包括（1）预防和缓解症状，（2）在实施前和实施期间评估每次治疗，（3）确保患者指定替代决策者并制定预先计划，以及（4）为患者和家人临近死亡做好准备。良好的护理可能需要与患者及其家人一起度过不可避免的困难时期。参加临终关怀计划要求决策者面对预后及其不确定性，考虑其他服务的可取性，认识到可用临终关怀计划之间的差异，解决财务问题，并权衡患者和亲人因被贴上“死亡”标签而承受的痛苦。临终关怀提供称职、持续和合理全面的护理，但也有一些限制。患有严重慢性疾病的人在临终时的功能和症状通常遵循以下三种轨迹之一：（a）临终时有短暂的明显衰退，这是癌症的典型特征； (b) 长期残疾，病情周期性恶化，死亡时间不可预测，其特点是死于慢性器官系统衰竭； (c) 自我护理缺陷和死亡进程缓慢，这通常是由于虚弱或痴呆造成的。对临终者的有效和可靠的护理将需要改变护理的组织和融资以适应这些轨迹，以及富有同情心和熟练的临床医生。
The case story of a 47-year-old man with advanced rectal carcinoma illustrates the professional services and care system strategies available to help clinicians serve patients coming to the end of life. For this patient, who understands his prognosis, primary care physician services include (1) prevention and relief of symptoms, (2) assessment of each treatment before and during implementation, (3) ensuring that the patient designates a surrogate decision-maker and makes advance plans, and (4) preparation of patient and family for the time near death. Good care may entail enduring unavoidably difficult times with patients and their families. Enrollment in a hospice program requires that decision-makers confront the prognosis and their uncertainties about it, consider the desirability of other services, recognize variations among available hospice programs, address financial issues, and weigh the distress of patients and loved ones at being labeled as "dying." Hospice provides competent, continuous, and reasonably comprehensive care, but it has some constraints. Function and symptoms for those living with serious chronic illness at the end of life generally follow 1 of 3 trajectories: (a) a short period of obvious decline at the end, which is typical of cancer; (b) long-term disability, with periodic exacerbations, and unpredictable timing of death, which characterizes dying with chronic organ system failures; or (c) self-care deficits and a slowly dwindling course to death, which usually results from frailty or dementia. Effective and reliable care for persons coming to the end of life will require changes in the organization and financing of care to match these trajectories, as well as compassionate and skillful clinicians.
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：
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作者：
Pantilat,SZ;Alpers,A;Wachter,RM
通讯作者：
Wachter,RM
重病患者家庭的经济困难是否与患者和代理人护理偏好相关？
DOI：
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发表时间：
1996
期刊：
Archives of internal medicine.
影响因子：
--
作者：
Covinsky,KE;Landefeld,CS;Teno,J;ConnorsJr,AF;Dawson,N;Youngner,S;Desbiens,N;Lynn,J;Fulkerson,W;Reding,D;Oye,R;Phillips,RS
通讯作者：
Phillips,RS