重症加護病房裡生命末期照護的溝通

Communication about End-of-life Care in the Intensive Care Unit

許煌汶(Huang-Wen Hsu)

《若瑟醫護雜誌》 3卷1期 (2009/06) Pp. 16-23

https://doi.org/10.30145/STJHMNJ.200906.0003

摘要

儘管醫療科技的進步，重症加護病房(intensive care unit, ICU)仍是重症病人常見的死亡地方。ICU的重症病人於治癒性治療無效時，常常面臨瀕死狀況進入生命末期；此時將照護重點轉移至緩和醫療，以緩解其痛苦並提昇生活品質，已經是國際間末期照護的趨勢。
目前台灣的癌末病人已可以獲得安寧緩和醫療的全人照顧，但對於非癌症末期病人，尤其是重症病人的緩和療護，則仍無共識。溝通是在ICU裡作生命末期緩和療護的關鍵因素，在病人的生命末期階段，臨床人員早一點有系統的與重症病人及其家屬，開放生命末期照護議題的溝通，對於重症末期照護的品質改善是有助益的。
本文針對開啟ICU生命末期緩和療護的溝通時機與內容，以及改善溝通的策略作一討論。

關鍵字

重症加護病房 ； 生命末期 ； 安寧緩和醫療 ； 溝通

並列摘要

Despite advanced medical technology the intensive care unit (ICU) remains a setting where death of the critically ill patients is common. When the curative treatment is ineffective to the ICU critically ill patients, they often become terminally ill patients. It has become an international trend to provide palliative end-of-life (EOL) care to these terminally ill patients for alleviating their suffering and improving quality of life.
To provide hospice and palliative care (HPC) for the terminally ill cancer patients was already developed in Taiwan nowadays. However, it still has no consensus in the HPC of non-cancer terminally ill patients. Communication is the key factor of performing palliative EOL care in the ICU. Initiating communication about palliative BOL care earlier and more systematically with ICU critically ill patients and their families is helpful to the quality of EOL care.
This article reviews the literature and explores the clinical indications of initiating the palliative EOL care communication, domains of palliative EOL care, and the strategies for improving EOL communication in the ICU.

並列關鍵字

intensive care unit ； end-of-life ； hospice and palliative care ； communication