Chair in Nursing, Centre for Quality and Patient Safety Research, Barwon Health Partnership, School of Nursing and Midwifery, Deakin University, Geelong, Australia.
School of Medicine, Deakin University and Clinical Director Palliative Care Services Barwon Health, Geelong, Australia.
Diabetes Res Clin Pract. 2018 Sep;143:454-463. doi: 10.1016/j.diabres.2017.09.018. Epub 2017 Oct 31.
Palliative and end of life care are essential, but largely overlooked, aspects of comprehensive, personalised diabetes care. Life expectancy is lower in people with diabetes than in the general population due to complications and comorbidities, especially those associated with obesity such as cardiovascular disease, frailty and cancer. This paper makes the case for early initiation of palliative care and proactive planning for end of life. Early use of palliative care improves symptom management, comfort and quality of life, and often improves function. Significantly, it reduces disease burden and unnecessary treatment. Prognostication is challenging, but tools such as the Gold Standard Framework and diabetes-related indicators of reduced life expectancy can help identify those at high risk one year mortality. Skilled conversations, underpinned by an evidence-based framework, are a critical component in helping people with diabetes, and their families, discuss these complex issues and make appropriate advance care plans based on their values and preferences.
姑息治疗和临终关怀是全面、个性化糖尿病护理中必不可少但在很大程度上被忽视的方面。由于并发症和合并症，尤其是与肥胖相关的并发症，如心血管疾病、虚弱和癌症，糖尿病患者的预期寿命比一般人群短。本文主张早期开始姑息治疗并积极规划临终事宜。早期姑息治疗可改善症状管理、舒适度和生活质量，并经常改善功能。重要的是，它可以减轻疾病负担和不必要的治疗。预后具有挑战性，但诸如黄金标准框架和与糖尿病相关的降低预期寿命指标等工具可以帮助识别一年内死亡风险高的患者。以循证框架为基础的有技巧的对话是帮助糖尿病患者及其家属讨论这些复杂问题并根据其价值观和偏好制定适当的预嘱的关键组成部分。
