这句话理解的对吗？谢谢

Pain Management in Palliative Care 

Palliative care involves pain and symptom management in the context of a patient with terminal disease, usually cancer. The skills of a consultation-liaison psychiatrist come to the fore in this setting, if complemented by pain medicine skills, because patients and families need support and guidance as they navigate the challenges of the end of life, in both health care and personal domains. Challenges faced in the health care domain include organizing palliative therapy for cancer, negotiating with physicians about pain and symptom treatment and sedation, deciding about hospice care, and considering advanced directives for care in terminal situations. The principles of pain management in terminal illness have been discussed above. Unlike chronic pain management in nonterminal patients, comfort and function usually outweigh safety in considering medications. The goal of treatment is to help the patient and family to maintain quality of life for as long as possible, not concern about longer-term effects of pain treatment. Skillful titration of medications, with the goals of pain and symptom control with preservation of mental competence and emotional strength, will help patients and families successfully manage the personal challenges of terminal illness. Pain management must be inventive and personalized. For example, when oral routes are not available, and patients wish to be **** of intravenous equipment, transmucosal (rectal) or subcutaneuous routes may be used. When feasible, point-specific radiation therapy to shrink tumors and procedures to interrupt neural tracts communicating pain signals to the CNS should be considered. Above all, patient and family attitudes about pain and its treatment, particularly about opioids, must be examined for biases that may complicate pain management at the end of life. Pain is not the only symptom that needs management in this setting. Frequently severe fatigue, nausea, delirium, shortness of breath, and depression may accompany terminal illness and its treatment. Treatment of these conditions with medication and psychophysiologic techniques such as relaxation should be aggressively pursued.

Challenges faced in the personal domain include managing financial and legal affairs, resolving conflicts about control and decisions that often arise when families convene to discuss advanced directives, considering spiritual needs, and maintaining the highest quality of life possible for as long as possible.

姑息治疗中的疼痛管理

姑息治疗涉及背景为终末期疾病（通常为癌症）患者的疼痛和症状管理。因为患者和家属在应对临终挑战时需要包括医疗保健和个人领域的支持和指导，在这种情况下，咨询-联络精神病学家的技能如果得到疼痛医学技能的补充就会崭露头角。姑息治疗领域面临的挑战包括：组织癌症的姑息治疗、与医生协商疼痛和症状治疗和镇静、决定临终关怀以及考虑临终关怀的高级指令。上文讨论了终末期疾病的疼痛管理原则。与非终末期患者的慢性疼痛管理不同，在考虑药物时，舒适度和功能性通常超过安全性。治疗的目标是帮助患者和家属尽可能长时间地维持生活质量，而不是担心疼痛治疗的长期效果。以保持心智能力和情感力量为目标的疼痛和症状控制来对药物进行娴熟的滴定，将帮助患者和家庭成功地应对绝症带来的个人挑战。疼痛管理必须创造性和个性化。例如，当口服途径不可用且患者不希望使用静脉注射设备时，可以使用经粘膜(直肠)或皮下途径。在可行的情况下，可以考虑通过定点放射治疗来缩小肿瘤，以及阻断神经束向中枢神经系统传递疼痛信号的过程。最重要的是，必须检查患者和家庭对疼痛及其治疗的态度，尤其是对阿片类药物的态度，以确定可能使临终疼痛管理复杂化的偏见。在这种情况下，疼痛并不是唯一需要处理的症状。严重的疲倦、恶心、神志不清、呼吸急促和抑郁常常伴随着晚期疾病及其治疗。这些疾病的治疗应积极采用药物和放松等心理生理学技术。

个人领域面临的挑战包括管理财务和法律事务，解决家庭聚会讨论晚期决定时经常出现的关于控制权和决策的冲突、考虑精神层面需求、以及尽可能长时间保持最高生活质量。

patient and family attitudes about pain and its treatment, particularly about opioids, must be examined for biases that may complicate pain management at the end of life. 必须检查患者和家庭对疼痛及其治疗的态度，尤其是对阿片类药物的态度，以确定可能使临终疼痛管理复杂化的偏见。这句话理解的对吗？谢谢

advanced directives晚期决定？是不是就是放弃还是再继续治疗之类的决定？