慢性阻塞性肺疾病晚期病人之安寧緩和醫療需求

The Hospice Palliative Care Needs of Patients with Advanced Chronic Obstructive Pulmonary Disease

10.6145/jme.201009_14(3).0001

陳亭儒(Ting-Ru Chen)；胡文郁(Wen-Yu Hu)；鄭之勛(Jih-Shuin Jerng)；陳慶餘(Ching-Yu Chen)

慢性阻塞性肺疾病 ； 安寧緩和 ； 照顧需求 ； 生命末期 ； advanced COPD ； hospice palliative care ； needs ； end-of-life

Journal of Medical Education

14卷3期（2010 / 09 / 01）

163 - 172

繁體中文

本文藉由文獻查證與臨床經驗，探討慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)晚期病人之安寧緩和照顧需求。結果顯示COPD晚期病人在生理層面，忍受複雜而困難症狀且未被適當地處理；心理靈性層面，病人出現負向情緒反應的比例相當高，靈性需求常被忽略；社會層面，出現社會隔離及家屬代為做決策情形；溝通方面，呈現病人對於生命末期臨床資訊與末期照護議題討論皆不足。文中也提出安寧療護於COPD晚期病人之應用，包括介入時機、從全人觀點進行症狀處置、全面評估心理靈性需求、運用社區資源與溝通生命末期照顧議題等。未來可考慮於醫療專業人員之養成教育或繼續教育課程增加此部份的內容，以提升對COPD晚期病人末期照顧的知識與照顧品質。

There has been a growing awareness of the hospice palliative care needs of the patients who suffer from non-malignant diseases, but they have not been well documented and therefore little is known about them. In general, the authors have considered that the use of a traditional cancer-based service model to predict the possible hospice palliative care needs of patients with advanced Chronic Obstructive Pulmonary Disease (COPD) to be inappropriate. Therefore, a literature review was conducted to identify the hospice palliative needs of patients with advanced COPD. The findings reveal that advanced COPD patients have significantly poorer physical, psycho-spiritual and social functioning. They suffered from multiple complicated symptoms that are usually poorly controlled. They also experience a high degree of emotional-spiritual distress and social isolation, but these are usually managed inadequately and may even be ignored. In addition, health care professionals tend to avoid discussion with or the initiation of communication with these patients in order to explore clinical issues and end of life care issues. As a result, these patients' needs in terms of information are unmet. Families therefore often become surrogate decision-makers. Based on a literature review, the authors suggest some strategies aimed at improving hospice palliative care among patients with advanced COPD. These include how to initiate end-of-life discussions, how to provide comprehensive assessment and care of the whole individual, and how to effectively utilize community resources. This area is a challenge for professionals and there is a great need to improve the quality of care of patients with advanced COPD. Based on the above findings, it is necessary that courses on hospice palliative care for patients with nonmalignant disease, particularly advanced COPD, should be added to professional medical education in the future.

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