Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
Palliative Medicine Physician, Denver Health & Hospital Authority, Denver, Colorado, USA.
J Pain Symptom Manage. 2021 Jun;61(6):1287-1296. doi: 10.1016/j.jpainsymman.2020.12.009. Epub 2020 Dec 19.
Palliative care (PC) and hospice services have experienced shortages before 2020, and during the initial phases of the current pandemic, more critical gaps are expected with future surges, much as scarcity in intensive care unit services may recur during the COVID-19 pandemic. Although ethical allocation of ventilators and intensive care unit care is the subject of important discussions during this pandemic, caring for those at the end of life and those not desiring or qualifying for critical interventions must not be neglected, as critical care and comfort-focused care are intertwined. We review state and regional gaps already recognized in planning for scarcity in PC and hospice services during this pandemic and describe the planning initiatives Colorado has developed to address potential scarcities for this vulnerable and diverse group of people. We hope to encourage other state and regional groups to anticipate needs in the coming surges of this pandemic or in public health crises to come. Such planning is key to avoid the degradation of care that may result if it is necessary to invoke crisis standards of care and ration these essential services to our communities.
缓和医疗（PC）和临终关怀服务在 2020 年之前就已经出现短缺，而在当前大流行的初始阶段，随着未来疫情的爆发，预计会出现更多的严重缺口，就像在 COVID-19 大流行期间，重症监护病房服务的稀缺性可能再次出现一样。尽管在当前大流行期间，呼吸机和重症监护病房护理的伦理分配是重要讨论的主题，但必须关注那些生命末期的患者和那些不希望或不符合接受关键干预措施的患者，因为重症监护和以舒适为重点的护理是相互交织的。我们回顾了在当前大流行期间规划缓和医疗和临终关怀服务短缺时已经认识到的州和地区差距，并描述了科罗拉多州为解决这一脆弱和多样化人群的潜在短缺而制定的规划举措。我们希望鼓励其他州和地区团体在未来的疫情爆发或即将到来的公共卫生危机中预测需求。这种规划是避免因有必要援引危机护理标准而导致护理质量下降并将这些基本服务配给给我们社区的关键。
