Hargadon Annemarie, Tran Quy, Stephen Karen, Homler Howard
1 Department of Internal Medicine, Section of Palliative Medicine, University of California, Davis School of Medicine , Sacramento, California.
2 Yolo Hospice, Davis, California.
J Palliat Med. 2017 Feb;20(2):207-210. doi: 10.1089/jpm.2016.0279. Epub 2017 Jan 5.
Patients are hospice eligible when they have an estimated prognosis of 6 months and the readiness to forgo attempts at disease-modifying treatments related to their terminal illness. The decision to enroll in hospice is relatively clear when the prognosis is based on an incurable illness for which there are no further life-prolonging therapies. However, when the prognosis is based on a serious chronic illness for which possible interventions remain but must be forgone to access hospice support, the decision process is more complex. Such patients may benefit from a trial of concurrent care, receiving both disease-modifying and comfort-focused hospice care, while determining whether or not to pursue further treatment.
This article illuminates the need for concurrent care for hospice patients with serious illness. We present a case to exemplify this gap and offer a framework for managing patients in transition between disease-modifying therapies and hospice care.
The case describes an 86-year-old woman with dry gangrene of her foot who was admitted to hospice for end-of-life care and, after a trial period on hospice, chose to pursue further treatment.
Integrating concurrent care into the Medicare Hospice Benefit allows patients to receive care that aligns with their values, even as they experience and collect new information about their condition. We propose the TRIAL framework to assess evolving goals of care for hospice patients with serious chronic illness.
当患者预计预后为6个月且愿意放弃针对其终末期疾病的疾病缓解治疗时，他们符合临终关怀条件。当预后基于无法治愈且没有进一步延长生命疗法的疾病时，进入临终关怀的决定相对明确。然而，当预后基于一种严重的慢性疾病，尽管仍有可能的干预措施，但为了获得临终关怀支持而必须放弃这些措施时，决策过程就更加复杂。这类患者可能会从同时进行的护理试验中受益，即接受疾病缓解治疗和以舒适为重点的临终关怀护理，同时决定是否继续接受进一步治疗。
本文阐明了对患有严重疾病的临终关怀患者进行同时护理的必要性。我们通过一个案例来说明这一差距，并提供一个框架，用于管理在疾病缓解治疗和临终关怀护理之间过渡的患者。
该案例描述了一名86岁足部干性坏疽的女性，她因临终关怀入院接受临终护理，在临终关怀试用期后，选择继续接受进一步治疗。
将同时护理纳入医疗保险临终关怀福利，使患者能够接受符合其价值观的护理，即使他们在体验和收集有关自身病情的新信息时也是如此。我们提出了TRIAL框架，以评估患有严重慢性疾病的临终关怀患者不断变化的护理目标。
