Most patients want some control over their medical care, including-or even especially-when they are too sick to participate in decisions. Clinicians who have to make decisions for patients who are unable to participate often would appreciate guidance from patients' wishes. Advance care planning responds to these needs. The process provides for discussions about goals in different scenarios and allows inclusion of the family and physician as well as the patient. It helps to have the patient and family complete validated worksheets that walk them through the various considerations and result in expressions of preference that are clinically meaningful. For the clinician, scenario-based goals for care and personal thresholds for when desired care shifts from primarily cure-oriented to primarily palliative are the most useful features to know about. The patient and family should do most of the discussing on their own time; the physician and team should coordinate to screen for problems and ensure agreement. Ideally, this should occur over the course of regular clinical encounters, with some dedicated time for the topic at suitable intervals.

中文翻译：

---

高级指令。

大多数患者都希望对他们的医疗服务有所控制，包括-甚至在病得太重而无法参与决策时。必须为无法参与治疗的患者做出决定的临床医生通常会喜欢患者意愿的指导。预先护理计划可以满足这些需求。该过程提供了有关不同情况下目标的讨论，并允许家人，医生以及患者参加。它有助于使患者和家属完成经过验证的工作表，这些工作表将引导他们进行各种考虑，并产生具有临床意义的偏好表达。对于临床医生而言，最有用的功能是了解基于情景的护理目标和个人阈值，以了解所需的护理何时从主要以治疗为中心转向主要为姑息治疗。患者和家属应自行安排大部分讨论；医生和团队应协调以筛查问题并确保达成共识。理想情况下，这应该在常规的临床交流过程中发生，并在适当的时间间隔内花一些时间进行主题讨论。