Introduction

Waiting until a person is very near end of life to discuss limited life expectancy risks lower goal-concordant care and increased utilization of medical interventions with lower likelihood of benefit at the end of life. Medical training on communication skills in serious illness often focuses on early and late conversations regarding prognosis, with no guidance on navigating the conversations occurring in the middle of the illness course.

Goal of the review

We propose a new framework for identifying and discussing prognosis at various points along the cancer course, as a continuum from beginning to end, that is prompted by changes in clinical status and number of available remaining cancer directed interventions.

Discussion

SPIKES is a framework utilized for early conversations in a cancer course. REMAP is a framework utilization for late conversations in a cancer course. There is a gap in guidance on how to navigate conversations that occur between the early and late phases of a cancer course. We describe 3 general phases of care during a cancer course (“early,” “middle,” and “late”), with each phase warranting specific communication skills in order to improve patient understanding of prognosis, goal concordant care, and best practices for healthcare utilization in the acute and end of life care settings.

Conclusion

Framing prognosis by available medical interventions through a framework of “early,” “middle,” and “late” adds clarity to the phase of illness, expectations around delivery of information to the patient, and framing of recommendations at each given phase.

中文翻译：

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下一个最好的事情：在不可治愈的癌症过程中传达预后的三个关键对话

介绍

等到一个人非常接近生命的尽头时才讨论有限的预期寿命风险，会降低目标一致性护理的风险，并增加医疗干预的利用，而在生命结束时受益的可能性较低。关于严重疾病沟通技巧的医学培训通常侧重于有关预后的早期和晚期对话，而没有指导如何在疾病过程中进行对话。

审查的目标

我们提出了一个新的框架，用于识别和讨论癌症病程中各个点的预后，作为从开始到结束的连续体，这是由临床状态和可用的剩余癌症定向干预措施数量的变化所促使的。

讨论

SPIKES 是一个用于癌症课程早期对话的框架。REMAP 是用于癌症治疗后期对话的系统应用。关于如何引导癌症病程早期和晚期之间发生的对话的指导存在差距。我们描述了癌症病程中的 3 个一般护理阶段（“早期”、“中期”和“晚期”），每个阶段都需要特定的沟通技巧，以提高患者对预后、目标一致护理和最佳实践的理解。急症和临终关怀环境中的医疗保健利用。

结论

通过“早期”、“中期”和“晚期”的框架，通过可用的医疗干预措施来制定预后，可以明确疾病的阶段、向患者提供信息的期望以及每个特定阶段的建议框架。