高齡病患腎臟替代療法醫病共享決策

Shared Decision Making in Geriatric Patients with End Stage Renal Disease

張惠雯(Hui-Wen Chang)

《台灣老年醫學暨老年學會雜誌》 16卷2期 (2021/05) Pp. 87-103

https://doi.org/10.29461/TGGa.202105_16(2).0001

摘要

末期腎臟疾病的老年患者後續治療計畫，應根據患者個人醫療期待、喜好和個別情況制訂。可以用預立醫療自主諮商方式討論，可能的醫療選項如血液透析、腹膜透析、或支持療法不進行透析等。醫病共享決策內容至少要包括臨床過程、治療目標、預後、生活品質，應給予患者及家屬充分的資訊來討論。當選擇不進行透析的選項時，醫療團隊也需積極給予患者支持性醫療及護理處置，並安慰家屬預期性哀傷以及安排臨終關懷。

關鍵字

末期腎臟疾病 ； 醫病共享決策 ； 高齡

並列摘要

Management for older adults with end-stage renal disease should be based on the patient's personal medical expectations, preferences and individual circumstances. Possible options of treatment include hemodialysis, peritoneal dialysis, or supportive care that can be coupled with processing advance care planning and signing advance directives Both patients and their family members should be offered sufficient time and guidance to discuss the contents of shared decision making which incorporate the clinical process, treatment goals, prognosis, and quality of life. When patients choose not to have any renal replacement therapy, the medical team should provide them with supportive hospice care and maximal symptomatic treatment and assist their family members in coping with anticipatory grief and subsequent mental support.

並列關鍵字

ESRD ； shared decision making ； older adults