Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.
Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Am J Transplant. 2017 Dec;17(12):3008-3019. doi: 10.1111/ajt.14522. Epub 2017 Nov 15.
Palliative care is an interprofessional approach that focuses on quality of life of patients who are facing life-threatening illness. Palliative care is consistently associated with improvements in advance care planning, patient and caregiver satisfaction, quality of life, symptom burden, and lower healthcare utilization. Most transplant patients have advanced chronic disease, significant symptom burden, and mortality awaiting transplant. Transplantation introduces new risks including perioperative death, organ rejection, infection, renal insufficiency, and malignancy. Numerous publications over the last decade identify that palliative care is well-suited to support these patients and their caregivers, yet access to palliative care and research within this population are lacking. This review describes palliative care and summarizes existing research supporting palliative intervention in advanced organ failure and transplant populations. A proposed model to provide palliative care in parallel with disease-directed therapy in a transplant program has the potential to improve symptom burden, quality of life, and healthcare utilization. Further studies are needed to elucidate specific benefits of palliative care for this population. In addition, there is a tremendous need for education, specifically for clinicians, patients, and families, to improve understanding of palliative care and its benefits for patients with advanced disease.
姑息治疗是一种跨专业的方法，专注于面临危及生命疾病的患者的生活质量。姑息治疗始终与改善预先护理计划、患者和护理人员的满意度、生活质量、症状负担以及降低医疗保健利用率相关。大多数移植患者患有晚期慢性疾病、严重的症状负担和等待移植的死亡率。移植会带来新的风险，包括围手术期死亡、器官排斥、感染、肾功能不全和恶性肿瘤。过去十年中的许多出版物都指出，姑息治疗非常适合支持这些患者及其护理人员，但在该人群中获得姑息治疗和研究的机会有限。本综述描述了姑息治疗，并总结了现有的研究，这些研究支持在晚期器官衰竭和移植人群中进行姑息治疗干预。在移植项目中同时提供姑息治疗和疾病导向治疗的拟议模型有可能改善症状负担、生活质量和医疗保健利用率。需要进一步的研究来阐明姑息治疗对这一人群的具体益处。此外，非常需要教育，特别是针对临床医生、患者和家属，以提高对姑息治疗及其对晚期疾病患者的益处的理解。
