- 期刊
末期腎病病人之預立醫療計畫
Advance Care Planning Discussions for Patients with End Stage Renal Disease
摘要
透析治療能成功延長生命，但末期腎病病人在接受透析治療後五年內死亡率仍維持在15~25%，因此，整合緩和醫療於腎臟照護領域顯得相當重要。因緩和醫療旨在減輕末期腎病病人之苦痛及增進生活品質，包含疼痛及症狀控制、預立醫療計畫(advance care planning, ACP)討論及哀傷輔導。從病人開始透析至停止透析的過程，ACP強調以病人爲中心，藉由不間斷的溝通，了解病人對末期照護的優先考量、協助病人找到希望與心靈安適，緩解家屬做決定的負擔及強化病人與所愛的人的關係，由此可見，ACP的執行並非強調完成預立指示文件的簽署，而是著重持續的溝通討論，讓家屬了解並尊重病人心願，最終提升病人與家屬的生命品質與照護滿意度。雖然目前臨床實務執行ACP仍存有許多阻礙及困境，然而醫療人員應作病人的代言人，且有責任改善病人臨終品質，因此，學習將ACP討論整合於病人照護計畫，才能兼顧病人倫理、社會與靈性上的需求，爲病人預約善終。
並列摘要
While dialysis therapy was succeed in life-prolonging, the 5-year mortality rates for patients with end stage renal disease still of 15~25%. As a result, integrating palliative care in renal disease has become crucial. Palliative care aims to relieve patients' suffering and improve the quality of life, encompassing pain and symptom control, initiate the discussion of advance care planning (ACP) and provide bereavement support. ACP discussions focus on the patient-centered process from start to stop dialysis, throughout the ongoing communication to define patient's key priories in end of life, assist patients find hope and achieve a sense of spiritual peace, relieve the burdens placed on others and strengthen relationships with loved ones. This shows the goals of ACP emphasized the process of ongoing discussion that enhance family understand and respect patients wishes, and help them improve the quality of life and care satisfaction rather than completing an advance directive document. However there are several barriers to effective ACP in clinical practice, medical staff are advocate of patients and have responsibility to improve the quality of dying. Therefore, learn how to integrate ACP discussion into nephrology care is that way meet patients needs in the ethical, psychosocial, and spiritual dimensions and assisted patients to achieve a good death.