Department of Communication Sciences and Disorders, Emerson College, Boston, Massachusetts, USA.
Department of Ambulatory Palliative Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
J Palliat Med. 2022 Jun;25(6):1004-1008. doi: 10.1089/jpm.2021.0487. Epub 2021 Dec 27.
Among patients seen by palliative care, dysphagia is prevalent and can lead to disturbing symptoms and challenges in medical decisions for patients and families. Our patient, AP, an 88-year-old woman with a history of thyroid cancer and esophageal dysmotility, was nearing end of life. She wanted nothing more than to eat her chocolate cake in peace. This shocked her family and also presented multiple ethical and logistical issues for the medical team caring for her during an acute admission for hypoxia. This case presents an opportunity to: review strategies for evaluating and diagnosing dysphagia; appraise evidenced based approach to the palliative management of dysphagia; and promote the education of families and staff regarding palliative options for care. Palliative care professionals can be instrumental in educating patients, families, other clinicians, including swallowing therapists, on how to enhance comfort and quality of life among patients with dysphagia.
在接受姑息治疗的患者中，吞咽困难很常见，可导致患者和家属感到不适，并对医疗决策造成挑战。我们的患者 AP 是一位 88 岁的女性，患有甲状腺癌和食管动力障碍，生命已临近尾声。她只想安静地吃她的巧克力蛋糕。这让她的家人感到震惊，也给在她因缺氧急性入院期间照顾她的医疗团队带来了多个伦理和后勤问题。这个病例提供了一个机会：回顾评估和诊断吞咽困难的策略；评估基于证据的方法对吞咽困难的姑息治疗；并促进对姑息治疗选择的教育，包括患者、家属和工作人员。姑息治疗专业人员可以在教育患者、家属和其他临床医生（包括吞咽治疗师）方面发挥重要作用，告知他们如何提高吞咽困难患者的舒适度和生活质量。
