Discontinuing active oncological treatment and initiating palliative care is a critical moment in cancer care, requiring oncologists to address complex clinical, ethical, and emotional challenges. This narrative review aims to provide clinicians with practical guidance for conducting conversations about treatment discontinuation and transitioning patients to palliative or hospice care. Drawing from current clinical guidelines, empirical research, and expert perspectives, the article reviews evidence-based communication strategies and frameworks, including the SPIKES protocol, Ask–Tell–Ask, the WHO model, and the disclosure model. The article also explores the clinical, functional, psychosocial, and ethical criteria relevant to treatment withdrawal decisions, as well as the timing and structure of end-of-life discussions. A practical algorithm is proposed, synthesizing key principles into a step-by-step guide for use in daily oncology practice. The algorithm supports clinicians in balancing medical indications with patient values and preferences, fostering shared decision-making and maintaining therapeutic relationships even in the most difficult circumstances. The review concludes that structured yet flexible communication enhances patient understanding, reduces unnecessary interventions, and improves the quality of end-of-life care. By promoting patient-centered care and timely palliative integration, this article offers oncologists a clear and adaptable approach to one of the most sensitive aspects of cancer care.
停止积极抗肿瘤治疗并启动姑息治疗是癌症诊疗中的关键节点，这要求肿瘤科医生应对复杂的临床、伦理及情感挑战。本文通过叙述性综述，旨在为临床医生提供关于终止治疗并转向姑息或安宁疗护沟通的实践指导。文章综合当前临床指南、实证研究及专家观点，系统回顾了包括SPIKES沟通模型、询问-告知-再询问法、WHO沟通模式及信息披露模型在内的循证沟通策略与框架。同时探讨了与治疗终止决策相关的临床指征、功能状态、社会心理及伦理标准，以及生命末期谈话的时机选择与结构安排。研究提出了一套整合核心原则的实践流程算法，为肿瘤临床日常工作提供分步指导。该算法支持临床医生在平衡医疗指征与患者价值观及偏好的基础上，促进医患共同决策，即使在最困难的情况下也能维持治疗关系。综述结论表明：结构化且灵活的沟通能提升患者理解度，减少不必要的医疗干预，并提高生命末期照护质量。通过倡导以患者为中心的照护理念及适时整合姑息治疗，本文为肿瘤科医生处理癌症诊疗中最敏感的环节提供了清晰且可操作的实践路径。
肿瘤(癌症)患者之家