Division of Nephrology, Stanford University School of Medicine and Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Healthcare System, Palo Alto, California, USA.
Curr Opin Nephrol Hypertens. 2010 Nov;19(6):556-60. doi: 10.1097/MNH.0b013e32833d67bc.
In this review, we outline the rationale for expanding the role of palliative care in end-stage renal disease (ESRD), describe the components of a palliative care model, and identify potential barriers in implementation.
Patients receiving chronic dialysis have reduced life expectancy and high rates of chronic pain, depression, cognitive impairment, and physical disability. Delivery of prognostic information and advance care planning are desired by patients, but occur infrequently. Furthermore, although hospice care is associated with improved symptom control and lower healthcare costs at the end of life, it is underutilized by the ESRD population, even among patients who withdraw from dialysis. A palliative care model incorporating communication of prognosis, advance care planning, symptom assessment and management, and timely hospice referral may improve quality of life and quality of dying. Resources and clinical practice guidelines are available to assist practitioners with incorporating palliative care into ESRD management.
There is a large unmet need to alleviate the physical, psychosocial, and existential suffering of patients with ESRD. More fully integrating palliative care into ESRD management by improving end-of-life care training, eliminating structural and financial barriers to hospice use, and identifying optimal methods to deliver palliative care are necessary if we are to successfully address the needs of an aging ESRD population.
在本篇综述中，我们概述了在终末期肾病（ESRD）中扩大姑息治疗作用的基本原理，描述了姑息治疗模式的组成部分，并确定了实施过程中的潜在障碍。
接受慢性透析的患者预期寿命缩短，且慢性疼痛、抑郁、认知障碍和身体残疾的发生率较高。向患者提供预后信息和预先护理计划是患者所期望的，但很少发生。此外，尽管临终关怀与改善终末期生命的症状控制和降低医疗保健成本相关，但在 ESRD 人群中并未得到充分利用，即使是那些停止透析的患者也是如此。包含预后沟通、预先护理计划、症状评估和管理以及及时转介临终关怀的姑息治疗模式可能会改善生活质量和临终质量。有资源和临床实践指南可帮助从业者将姑息治疗纳入 ESRD 管理。
减轻 ESRD 患者的身体、心理社会和存在痛苦的需求很大。如果我们要成功满足老龄化 ESRD 人群的需求，就需要通过改善临终关怀培训、消除使用临终关怀的结构和财务障碍以及确定提供姑息治疗的最佳方法，更充分地将姑息治疗纳入 ESRD 管理。
