When patients are diagnosed with cancer, primary care physicians often must deliver the bad news, discuss the prognosis, and make appropriate referrals. When delivering bad news, it is important to prioritize the key points that the patient should retain. Physicians should assess the patient’s emotional state, readiness to engage in the discussion, and level of understanding about the condition. The discussion should be tailored according to these assessments. Often, multiple visits are needed. When discussing prognosis, physicians should be sensitive to variations in how much information patients want to know. The challenge for physicians is to communicate prognosis accurately without giving false hope. All physicians involved in the patient’s care should coordinate their key prognosis points to avoid giving the patient mixed messages. As the disease progresses, physicians must reassess treatment effectiveness and discuss the values, goals, and preferences of the patient and family. It is important to initiate conversations about palliative care early in the disease course when the patient is still feeling well. There are innovative hospice programs that allow for simultaneous curative and palliative care. When physicians discuss the transition from curative to palliative care, they should avoid phrases that may convey to the patient a sense of failure or abandonment. Physicians also must be cognizant of how cultural factors may affect end-of-life discussions. Sensitivity to a patient’s cultural and individual preferences will help the physician avoid stereotyping and making incorrect assumptions. (Am Fam Physician. 2008;77(2):167-174. Copyright © 2008 American Academy of Family Physicians.)
Category: final de la vida
Publicadas recomendaciones para cuidados al final de la vida
El último número de Annals of Internal Medicine muestra tres artículos que examinan el cuidado paliativo y del final de la vida. Cada uno incluye una útil tabla, para facilitar seguir las múltiples recomendaciones.El primero comprende guías escritas por el comité del American College of Physicians (ACP), que recomienda que los médicos:
- evalúen regularmente a los pacientes con dolor, disnea y depresión;
- usen terapias efectivas para tratar dolor y depresión;
- usen opioides para disnea refractaria y oxígeno para hipoxia
- se aseguren que haya planeación, incluyendo directivas avanzada.
El segundo artículo, una actulización en medicina paliativa, aconseja a los médicos que:
- usen el modelo de Seattle para predecir mortalidad en falla cardiaca;
- detengan la práctica de no usar opioides por miedo que apresuren la muerte;
- consideren usar lidocaina intravenosa o mexiletina oral para dolor neuropático refractario;
- consideren referir pacientes con obstrucción gastroduodenal maligna para dilatación luminal.
El tercer artículo revisa evidencia publicada para apoyar varias medidas del final de la vida.
Guías de la ACP
Actualización en medicina paliativa
Revisión de la evidencia sobre el cuidado al final de la vida
Modelo de Seattle para evaluar falla cardiaca
Atencion Primaria 