COPD 患者的姑息治疗提供：肺科医生和全科医生的调查。
Provision of Palliative Care in Patients with COPD: A Survey Among Pulmonologists and General Practitioners.
机构信息
Public Health & Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
Lung Alliance Netherlands, Amersfoort, the Netherlands.
出版信息
Int J Chron Obstruct Pulmon Dis. 2021 Mar 26;16:783-794. doi: 10.2147/COPD.S293241. eCollection 2021.
INTRODUCTION
Patients with advanced chronic obstructive pulmonary disease (COPD) experience significant symptom burden, leading to poor quality of life. Although guidelines recommend palliative care for these patients, this is not widely implemented and prevents them from receiving optimal care.
OBJECTIVE
A national survey was performed to map the current content and organization of palliative care provision for patients with COPD by pulmonologists and general practitioners (GPs) in the Netherlands.
METHODS
We developed a survey based on previous studies, guidelines and expert opinion. Dutch pulmonologists and GPs were invited to complete the survey between April and August 2019.
RESULTS
130 pulmonologists (15.3%; covering 76% of pulmonology departments) and 305 GPs (28.6%) responded. Median numbers of patients with COPD in the palliative phase treated were respectively 20 and 1.5 per year. 43% of pulmonologists and 9% of GPs reported some formalized agreements regarding palliative care provision. Physicians most often determined the start of palliative care based on clinical expertise or the Surprise Question. 31% of pulmonologists stated that they often or always referred palliative patients with COPD to a specialist palliative care team; a quarter rarely referred. 79% of the respondents mentioned to often or always administer opioids to treat dyspnea. The topics least discussed were non-invasive ventilation and the patient's spiritual needs. The most critical barrier to starting a palliative care discussion was difficulty in predicting the disease course.
CONCLUSION
Although pulmonologists and GPs indicated to regularly address palliative care aspects, palliative care for patients with COPD remains unstructured and little formalized. However, our data revealed a high willingness to improve this care. Clear guidance and standardization of practice are needed to help providers decide when and how to initiate discussions, when to involve specialist palliative care and how to optimize information exchange between care settings.
简介
患有晚期慢性阻塞性肺疾病（COPD）的患者会经历严重的症状负担，导致生活质量下降。尽管指南建议对这些患者进行姑息治疗，但这并未得到广泛实施，导致他们无法获得最佳护理。
目的
对荷兰的肺病专家和全科医生（GP）对 COPD 患者进行姑息治疗的内容和组织进行全国性调查，以了解姑息治疗的现状。
方法
我们根据以往的研究、指南和专家意见制定了一份调查问卷。荷兰的肺病专家和全科医生被邀请在 2019 年 4 月至 8 月期间完成这项调查。
结果
共有 130 名肺病专家（15.3%；涵盖了 76%的肺病科）和 305 名全科医生（28.6%）做出了回应。每位肺病专家每年治疗处于姑息阶段的 COPD 患者数量中位数为 20 人，每位全科医生的数量中位数为 1.5 人。43%的肺病专家和 9%的全科医生报告称，他们在姑息治疗方面有一些正式的协议。医生通常根据临床专业知识或“Surprise Question”来确定姑息治疗的开始。31%的肺病专家表示，他们经常或总是将患有 COPD 的姑息治疗患者转介给专业姑息治疗团队；四分之一的医生很少这样做。79%的受访者表示，他们经常或总是开阿片类药物来治疗呼吸困难。讨论最少的话题是非侵入性通气和患者的精神需求。启动姑息治疗讨论的最大障碍是难以预测疾病进程。
结论
尽管肺病专家和全科医生表示经常讨论姑息治疗方面的问题，但 COPD 患者的姑息治疗仍然缺乏结构和正式化。然而，我们的数据显示，他们非常愿意改善这种护理。需要明确的指导和规范实践，以帮助提供者决定何时以及如何开始讨论，何时需要转介到专业姑息治疗，以及如何优化护理环境之间的信息交流。
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