安寧緩和療護和降血脂肪藥品處方優化在高血脂肪症末期病人之利害關係：文獻綜合分析

The Benefit-Harm between Hospice and Palliative Care and Deprescribing Hypolipidemic Treatment in Hyperlipidemic Terminally Ill Patients: Integrative Literature Analysis

陳偉熹(Wei-Hsi Chen) ； 賴亭伃(Ting-Yu Lai) ； 陳潔宜(Chieh-I Chen) ； 趙千淑(Cian-Shu Chao) ； 林綉虹(Siou-Hong Lin) ； 林宏昇(Hung-Sheng Lin)

《安寧療護雜誌》 26卷1期 (2021/12) Pp. 40-51

https://doi.org/10.6537/TJHPC.202112_26(1).03

摘要

為了避免多重藥品傷害和無效醫療，處方優化已經是安寧緩和療護的一個重要任務。降血脂肪藥品被認為對末期病人的高血脂肪症治療沒有明顯療效，亦非末期症狀緩解必備之藥品，且會增加身體副作用，故早被列入處方優化對象。然而，病人可能存在個別差異，在進行處方優化時，宜針對其利弊得失進行臨床倫理決策。本文使用系統性文獻回顧及統合分析搜尋和分析中、英文醫療相關文獻，企圖了解高血脂肪症末期病人在停止或繼續使用降血脂肪藥品對生活品質之影響。結果文獻中只有三篇研究符合本文目的，其證據水平並不高。雖然這些研究無法清楚呈現明確的解答，但是吾人依據整體文獻分析結果，認為降血脂肪藥品治療對高血脂肪症末期病人應具疾病特異性影響，停止或繼續使用須從個案單獨分析。因此，建議在尊重告知同意和自主原則之下，基於科學、經驗和誠信，耐心與末期病人討論高血脂肪症處置策略。

關鍵字

安寧緩和療護 ； 高血膽固醇 ； 高血三酸甘油脂 ； 高血脂肪 ； 處方優化 ； 告知同意 ； 自主原則

並列摘要

To avoid polypharmacy and futile medicine, deprescription is generally acknowledged a good practice indicator for hospice and palliative care. Since hypolipidemic drug does not involve symptom control, is considered to display no benefit for hospice/palliative care, and may cause adversity, it has been listed in the list of deprescription in terminally ill patients. However, deprescription should be individually tailored when hypolipidemic treatment can reduce the mortality of hyperlipidemia-related diseases. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we searched the English and Chinese medical database to elucidate the impact of survival rate and quality of life in hyperlipidemic terminal patients between withdrawal or continuation of hypolipidemic treatment in this study. Finally, there were only three publications to have fulfilled our criteria. The level of evidence was not high. Nevertheless, these studies still suggested that hypolipidemic treatment retained disease-specific effect in hyperlipidemic terminal patients. Regarding to respecting the inform-consent doctrine and autonomy, physicians should patiently discuss the policy and possible harm of deprescription in a case-by-case matter for treating hyperlipidemia based on scientific knowledge, experience, and faithfulness.

並列關鍵字

hospice and palliative care ； hypercholesterolemia ； hypertriglyceridemia ； hyperlipidemia ； deprescription ； inform consent ； autonomy

參考文獻

National Hospice and Palliative Care Organization: Hospice Medication Deprescribing Toolkit. From https://www.nhpco.org/wp-content/uploads/NHPCO_Deprescribing_Toolkit.pdf. Accessed at April 25, 2021.

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