叙事医学在晚期肿瘤患者安宁缓和医疗中的临床应用

The clinical application of narrative medicine in the hospice and palliative care of advanced cancer

安宁缓和医疗不仅关注患者的身体症状,也关注其心理、社会、精神等方面的问题。笔者所在的团队将叙事医学融入安宁缓和医疗临床实践,历时半年,梳理了数十例临床案例。基于此研究,本文总结了叙事医学在晚期肿瘤患者安宁缓和医疗实践中的优势,并分享了8个典型案例,说明通过合理告知病情、尊重患者自主权,可以实现医患共同决策,增进医患双方的信任,建立医务人员与患者及其家属之间更加紧密的联结;通过医患共同叙事,可以提升医务工作者的共情能力,引导患者合理纾解自身情绪;通过叙事的方法与患方谈论死亡,可以尽量做到生死两相安;通过叙事,可以关照家属的心理变化。

Hospice and palliative care not only focuses on patients’physical symptoms,but also their psychological,social and spiritual problems.The author’s team integrated narrative medicine into the clinical practice of hospice and palliative care,and reviewed dozens of clinical cases for six months.Based on the research,this paper summarizes the narrative medicine in patients with advanced tumor advantage in hospice and palliative care practice,and share the eight typical cases and explain by reasonable condition,respect for patient autonomy,can realize the doctor-patient decisions to improve doctor-patient trust between the two sides together,established between medical staff and patients and their families closer bond;Through doctor-patient narration,the empathy ability of medical workers can be improved,and patients can be guided to relieve their emotions reasonably.By talking about death with patients through narrative method,we can try our best to achieve peace between life and death.Through narration,the psychological changes of family members can be taken care of.