Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
Chest. 2013 Mar;143(3):736-743. doi: 10.1378/chest.12-0830.
The provision of effective palliative care is of great importance to patients awaiting lung transplantation. Although the prospect of lung transplantation provides hope to patients and their families, these patients are usually very symptomatic from their underlying disease.
An e-mail questionnaire was sent to members of the American College of Chest Physicians' Transplant NetWork and the Pulmonary Council of the International Society for Heart and Lung Transplantation (ISHLT). The survey included questions about barriers to providing palliative care, the availability of palliative care services, and recommended strategies to improve palliative care for lung transplant candidates.
The 158 respondents represented approximately 65% of transplant programs in the ISHLT registry. Respondents were in practice a mean of 11.3 (± 9) years, 70% were pulmonologists, 17% were surgeons, and 13% were other care providers. Barriers were classified into domains including patient factors, family factors, physician factors, and institutional/transplant program/lung allocation system factors. Significant patient/family barriers included unrealistic patient/family expectations about survival, unwillingness to plan end-of-life care, concerns about abandonment or inappropriate care after enrollment in a palliative care program, and family disagreements about care goals. For institutional/program/allocation system barriers, only the requirement for weight loss or gain to meet program-specific BMI requirements was identified. Significant physician barriers included competing time demands and the seemingly contradictory goals of transplant vs palliative care. Strategies recommended to improve palliative care included routine advance care planning for patients awaiting transplantation, access to palliative care specialists, training of transplant physicians in symptom management, and regular meetings among transplant physicians, nurses, patients, and families.
Physicians providing care to lung transplant candidates reported considerable barriers to the delivery and acceptance of palliative care and identified specific strategies to improve palliative care for lung transplant candidates.
为等待肺移植的患者提供有效的姑息治疗非常重要。尽管肺移植的前景给患者及其家属带来了希望，但这些患者通常因基础疾病而出现严重症状。
向美国胸科医师学会移植网络和国际心肺移植学会（ISHLT）肺科委员会的成员发送了电子邮件调查问卷。该调查包括有关提供姑息治疗的障碍、姑息治疗服务的可用性以及改善肺移植候选者姑息治疗的建议策略的问题。
158 名受访者代表了 ISHLT 登记处大约 65%的移植项目。受访者的从业年限平均为 11.3（±9）年，70%是肺病专家，17%是外科医生，13%是其他医护人员。障碍分为患者因素、家庭因素、医生因素和机构/移植项目/肺分配系统因素四个领域。显著的患者/家庭障碍包括对生存的不切实际的患者/家庭期望、不愿意规划临终关怀、对参加姑息治疗计划后被遗弃或接受不适当护理的担忧，以及对护理目标的家庭分歧。对于机构/项目/分配系统障碍，仅发现了体重减轻或增加以满足特定项目 BMI 要求的要求。显著的医生障碍包括竞争的时间需求和移植与姑息治疗之间看似矛盾的目标。建议改善姑息治疗的策略包括为等待移植的患者进行常规的预先护理计划、获得姑息治疗专家的支持、对移植医生进行症状管理培训，以及定期举行移植医生、护士、患者和家属之间的会议。
为肺移植候选者提供护理的医生报告了在提供和接受姑息治疗方面存在相当大的障碍，并确定了改善肺移植候选者姑息治疗的具体策略。
