谈论死亡对病人有利

谈论死亡可能令人不快，但是医生与绝症晚期病人坦率地谈论死亡不会带来伤害，反而能给病人和他们的亲人带来很多好处。

研究发现，死亡临近之际谈论自己需要何种护理的病人比不谈论者的生活质量更好，而且陷入沮丧的倾向未见增加。

发表在《美国医学会期刊》上的报告称，谈论过死亡的病人较少接受猛烈的医学干预，包括使用呼吸机或加护病房。而如果能避免猛烈医学干预，亲属看护人在病人死後几个月更不容易陷入沮丧。

波士顿Dana-Farber癌症研究所的赖特（Alexi Wright）博士在电话采访中表示，此前的研究显示，医生和病人在谈论死亡时倾向于使用含糊的言辞，往往避免直接讨论。

但赖特说：“我们的主要发现是，有关死亡的讨论让病人和他们的亲人都获益匪浅。”

来源：http://www.medicalnewstoday.com/articles/124669.php

Despite the long-held belief by many doctors that discussing end-of-life issues with patients increases the patients' emotional distress, such conversations can actually lead to improved quality of life -- both for patients and their loved ones, Dana-Farber Cancer Institute researchers and colleagues have found.

In a study published in the Oct. 8 issue of theJournal of the American Medical Association, investigators show that patients who reported having end-of-life discussions with their physicians did not feel more depressed, worried, or sad than those who did not. Patients who recalled such talks were more likely to accept that their illness was terminal and prefer comfort care over life-extending therapies. They received less aggressive medical treatment, such as resuscitation or admission to an intensive care unit, and they were more apt to enroll earlier in hospice programs.

More aggressive medical care, which can cause upsetting side effects and hamper communication with loved ones, was associated with worse patient quality of life and worse adjustment by patients' bereaved caregivers.

"Overall, patients who received less aggressive care at the end of life were thought to have better quality of life by their family members and other informal caregivers," says first author Alexi Wright, MD, a hematology-oncology fellow at Dana-Farber and a research scholar in Dana-Farber's Center for Psycho-Oncology and Palliative Care Research.

Particularly striking to Wright was the impact of patients' end-of-life experiences on their loved one's ability to cope with their losses. For example, individuals whose loved ones died in an ICU were three times more likely to develop a major depressive disorder than informal caregivers whose loved ones didn't receive such intensive care.

"Our results suggest that end-of-life discussions may have cascading benefits for patients and their caregivers," the authors note. Adds Wright, "The way people die has a profound impact on the way their loved ones live on afterwards."

End-of-life conversations allow dying individuals to express wishes for the medical care they want to receive. However, these talks require facing their mortality and the limitations of treatments; about 20 percent of patients don't want to discuss death, according to Wright.

"This study extends our understanding of the end-of-life experience," says senior author Holly Prigerson, PhD, study principal investigator and director of Dana-Farber's Center for Psycho-Oncology and Palliative Care Research. "To the best of our knowledge, it is the first to show how care received affects the dying patient's quality of life, and the first to show that a patient's health care and quality of life near death significantly influence the adjustment of his or her bereaved survivors."

The analysis was based on interviews with 332 patients and their caregivers at seven different outpatient sites in Connecticut, Texas, and Massachusetts, including Dana-Farber. After a patient died, investigators reviewed his/her medical record and interviewed the informal caregivers (such as spouses or adult children).

These patients were part of Coping with Cancer, a six-year longitudinal study of more than 600 adult terminally ill cancer patients and their caregivers recruited between 2002 and 2008. Participants tended to be younger, female, uninsured, and a member of an ethnic minority group than the population at large.

Preliminary results were announced this past June during the American Society of Clinical Oncology's annual meeting.

Wright hopes the findings will not only spark additional research on communication at life's end but encourage more physicians to be open with their dying patients. "I still take a deep breath before I start an end-of-life conversation," says Wright, who sees patients with gastrointestinal and other cancers. "We all wish we had different answers and better news, but it's important for us to be both frank and empathetic to give patients and their families a chance to prepare for death."

TAG: 病人 死亡 谈论