Lavesen Marie, Marsa Kristoffer Bastrup-Madsen, Bove Dorthe Gaby
Registered Nurse, Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Hillerød, Denmark.
Consultant, Department of Palliative Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark.
Int J Palliat Nurs. 2018 Feb 2;24(2):64-68. doi: 10.12968/ijpn.2018.24.2.64.
Patients with chronic obstructive pulmonary disease (COPD) often live with unmet palliative needs and low quality of life, although several guidelines recommend that those with COPD should be offered early and integrated palliative care. However, none of the guidelines describe how these recommendations can be operationalised and the current literature offers little information about experiences with developing and implementing new palliative care services. This article offers insight into the experience of developing and implementing a new palliative outpatient structure for patients with severe COPD. All patients are assigned to a nurse who has overall responsibility for establishing and maintaining an individualised relationship with the patient and identifying their needs for care and treatment. Routine outpatient visits are replaced by ad hoc consultations, and patients are seen by pulmonary specialists only when there is a need for medical assessment and treatment or a planned advanced care planning dialogue. The new service was succesfully implemented; however, the changes required good multidisciplinary collaboration, dedicated health professionals and managerial support. This paper highlights the need for further studies to investigate the effectiveness of new palliative care interventions for patients with COPD.
慢性阻塞性肺疾病（COPD）患者常常存在未得到满足的姑息治疗需求，生活质量较低，尽管多项指南建议应为COPD患者提供早期综合姑息治疗。然而，没有一项指南描述了如何将这些建议付诸实践，而且目前的文献几乎没有提供关于开发和实施新的姑息治疗服务经验的信息。本文深入探讨了为重度COPD患者开发和实施新的姑息门诊结构的经验。所有患者都被分配给一名护士，该护士全面负责与患者建立并维持个性化关系，确定其护理和治疗需求。常规门诊就诊被临时会诊取代，只有在需要进行医学评估和治疗或计划进行高级护理规划对话时，患者才会由肺科专家诊治。新服务成功实施；然而，这些变革需要良好的多学科协作、专业的医护人员和管理支持。本文强调需要进一步研究，以调查针对COPD患者的新姑息治疗干预措施的有效性。
