Yohannes Abebaw Mengistu
Department of Physiotherapy, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, UK.
Health Qual Life Outcomes. 2007 Apr 3;5:17. doi: 10.1186/1477-7525-5-17.
Chronic obstructive pulmonary disease (COPD) is a major cause of disability, morbidity and mortality in old age. Patients with advanced stage COPD are most likely to be admitted three to four times per year with acute exacerbations of COPD (AECOPD) which are costly to manage. The adverse events of AECOPD are associated with poor quality of life, severe physical disability, loneliness, and depression and anxiety symptoms. Currently there is a lack of palliative care provision for patients with advanced stage COPD compared with cancer patients despite having poor prognosis, intolerable dyspnoea, lower levels of self efficacy, greater disability, poor quality of life and higher levels of anxiety and depression. These symptoms affect patients' quality of life and can be a source of concern for family and carers as most patients are likely to be housebound and may be in need of continuous support and care. Evidence of palliative care provision for cancer patients indicate that it improves quality of life and reduces health care costs. The reasons why COPD patients do not receive palliative care are complex. This partly may relate to prognostic accuracy of patients' survival which poses a challenge for healthcare professionals, including general practitioners for patients with advanced stage COPD, as they are less likely to engage in end-of-life care planning in contrast with terminal disease like cancer. Furthermore there is a lack of resources which constraints for the wider availability of the palliative care programmes in the health care system. Potential barriers may include unwillingness of patients to discuss advance care planning and end-of-life care with their general practitioners, lack of time, increased workload, and fear of uncertainty of the information to provide about the prognosis of the disease and also lack of appropriate tools to guide general practitioners when to refer patients for palliative care. COPD is a chronic incurable disease; those in an advanced stage of the disease pursuing intensive medical treatment may also benefit from the simultaneous holistic care approach of palliative care services, medical services and social services to improve quality of end of life care.
慢性阻塞性肺疾病（COPD）是老年人残疾、发病和死亡的主要原因。晚期慢性阻塞性肺疾病患者每年因慢性阻塞性肺疾病急性加重（AECOPD）而入院的可能性最高可达三到四次，治疗费用高昂。AECOPD的不良事件与生活质量差、严重身体残疾、孤独以及抑郁和焦虑症状有关。目前，与癌症患者相比，晚期慢性阻塞性肺疾病患者缺乏姑息治疗，尽管他们预后较差、呼吸困难难以忍受、自我效能水平较低、残疾程度更高、生活质量差以及焦虑和抑郁程度更高。这些症状会影响患者的生活质量，并且可能成为家庭和护理人员担忧的根源，因为大多数患者可能足不出户，可能需要持续的支持和护理。为癌症患者提供姑息治疗的证据表明，这可以提高生活质量并降低医疗保健成本。慢性阻塞性肺疾病患者未接受姑息治疗的原因很复杂。这部分可能与患者生存的预后准确性有关，这给医疗保健专业人员带来了挑战，包括晚期慢性阻塞性肺疾病患者的全科医生，因为与癌症等终末期疾病相比，他们不太可能参与临终护理规划。此外，缺乏资源限制了医疗保健系统中姑息治疗项目的更广泛提供。潜在障碍可能包括患者不愿意与全科医生讨论预先护理计划和临终护理、时间不足、工作量增加、担心提供有关疾病预后信息的不确定性，以及缺乏适当工具来指导全科医生何时将患者转介接受姑息治疗。慢性阻塞性肺疾病是一种慢性不治之症；处于疾病晚期且接受强化医疗治疗的患者也可能受益于姑息治疗服务、医疗服务和社会服务同时采用的整体护理方法，以提高临终护理质量。
