癌症末期病人合併肺結核的治療及照護考量

Treatment and Care Considerations for Terminal Cancer Patients with Pulmonary Tuberculosis Complications

江至祥(Chih-Hsiang Chiang) ； 黃馨葆(Sin-Bao Huang) ； 蔡佩渝(Pei-Yu Tsai) ； 巫震宇(Jenn-Yu Wu) ； 周德馨(Te-Hsin Chou) ； 陳昱伃(Li-Yu Chen) ； 林益卿(I-Ching Lin)

《安寧療護雜誌》 19卷2期 (2014/07) Pp. 155-167

https://doi.org/10.6537/TJHPC.2014.19(2).3

摘要

癌症末期病人免疫力低，本身即肺結核高危險族群。二者亦可能有類似症狀，如持續咳嗽、發燒、體重降低等。肺結核除影響癌末病人治療的利弊考量外，對家屬、安寧團隊、甚至志工都有健康上的威脅。安寧團隊對於可能的結核病症狀、偵測、治療與隔離考量要有一定認識，才能對癌末併結核病人做出最適當的建議。癌末病人病情隨時可能變化，在治療前應與病人及家屬做一完整溝通，考量病人狀況、家庭功能、居家環境、防疫政策、預期結果等，俾能協助在院或居家隔離及治療與否的決策。本文以彰化基督教醫院安寧緩和病房一年內三例肺結核個案照顧經驗為本，結合文獻、法條探索與專家、臨床實務者意見，探討癌末病人併肺結核相關治療、隔離與臨床倫理困境。癌末併感染肺結核之病人因隔離考量，常與安寧療護鼓勵病人及家屬親密互動有衝突之處。且因其預期存活期短，台灣人有留一口氣在家往生的觀念，須個別化的考慮病人及家屬之情況與相關倫理議題，方能兼顧公眾利益且達到病人善終的目的。

關鍵字

癌症末期 ； 肺結核 ； 醫學倫理 ； 醫療決策 ； 安寧緩和醫療

並列摘要

With weakened immune systems, terminal cancer patients surely belong to the high-risk TB group; with both tending to have similar symptoms, such as persistent cough, fever, and weight loss. In addition to considering the impact the treatment and care methods used on terminal cancer patients with TB may cause, the threat to health of the patients' family, the hospice palliative care team, and even voluntary caretakers should also be taken into consideration. Members of the hospice palliative care team need to be knowledgeable about the TB symptoms, diagnosis, treatment, and quarantine, so as to provide appropriate care for terminal cancer patients with TB complications. The health conditions of a terminal cancer patient can change at any time. Therefore, before medical treatment begins, the medical team should have a thorough discussion with the patient and their family about the patient's illness, family functions, home environment, as well as epidemic prevention and expected treatment results, so that the decision on whether to prescribe hospitalized treatment or home quarantine care can be appropriately made. This research paper is based on 3 real cases of terminal cancer patients with TB in the hospice palliative care ward of Changhua Christian Hospital. The study combines literatures, law articles, as well as expert and clinic advices, to explore the medical treatments, quarantine measures, and clinic ethical dilemmas faced in treating terminal cancer patients with TB complications. The consideration of quarantine treatment for terminally ill TB patients is often contradictory to the hospice palliative practices of encouraging intimate interactions between the patients and their family members. It is just because terminally ill patients have very a short time to live, Taiwanese want their beloved ones to have the last breath at home. Therefore, it is necessary to take into account the conditions of individual patients and their families as well as the relevant ethical issues, so that both the public interests and final care for terminal patients can be well taken care of.

並列關鍵字

terminal cancer ； Pulmonary Tuberculosis (TB) ； medical ethics ； medical decision making ； Hospice Palliative Care