Iaboni Andrea, Grigorovich Alisa, Barned Claudia, Rodrigues Kevin, Pia Kontos, Chu Charlene H, Astell Arlene J, Flint Alastair, Bingham Kathleen, Maxwell Colleen J, Kirkham Julia, McMurray Josephine, Quirt Hannah, Tsokas Mario
Toronto Rehab, University Health Network, Toronto, ON, Canada.
University of Toronto, Toronto, ON, Canada.
Alzheimers Dement. 2021 Dec;17 Suppl 8(Suppl 8):e054003. doi: 10.1002/alz.054003.
Long-term care (LTC) residents have been disproportionately impacted by the COVID-19 pandemic, both from the virus itself and the restrictions in effect for infection prevention and control. Many barriers exist in LTC to prevent the effective isolation of suspect or confirmed COVID-19 cases. Furthermore, these measures have a severe impact on the well-being of LTC residents. Our aim was to develop a guide for long-term care to address the ethical challenges associated with isolating dementia patients during the pandemic. The Dementia Isolation Toolkit (DIT) was developed by members of the research team in partnership with LTC stakeholders to address: 1) the practical challenges of isolating or quarantining people with dementia in a compassionate, safe, and effective manner; and 2) the need for ethical guidance to support decision-making regarding isolation and infection control in LTC, to prevent indecision and moral distress. To develop the DIT the team reviewed and synthesized the literature on pandemic ethics in a plain-language document, which was then reviewed by our partners and stakeholders. The final ethical guidance tool includes a discussion of the ethics around infection control measures in a pandemic, an ethical decision-making tool, and a person-centred isolation care planning tool. The ethical guidance tool has been downloaded more than 6500 times since it was published (bit.ly/dementiatoolkit), and has been disseminated internationally. The worksheets are being used during outbreaks to support care and decision-making, as well as proactively, to prepare for outbreaks by developing isolation care plans. There is a need for support for ethical decision-making in the context of a pandemic, particularly in settings such as LTC. Future studies will evaluate the implementation of the tool and its impact in addressing moral distress in health care providers in long-term care.
长期护理（LTC）机构的居民受到新冠疫情的影响尤为严重，这既源于病毒本身，也源于为预防和控制感染而实施的限制措施。长期护理机构存在诸多障碍，阻碍了对疑似或确诊新冠病例的有效隔离。此外，这些措施对长期护理机构居民的福祉产生了严重影响。我们的目标是制定一份长期护理指南，以应对疫情期间隔离痴呆症患者所带来的伦理挑战。痴呆症隔离工具包（DIT）由研究团队成员与长期护理利益相关者合作开发，旨在解决：1）以富有同情心、安全且有效的方式隔离或检疫痴呆症患者的实际挑战；2）需要伦理指导来支持长期护理机构中关于隔离和感染控制的决策，以防止犹豫不决和道德困扰。为了开发DIT，团队以通俗易懂的文件形式回顾并综合了关于疫情伦理的文献，然后由我们的合作伙伴和利益相关者进行了审查。最终的伦理指导工具包括对疫情期间感染控制措施的伦理讨论、一个伦理决策工具以及一个以患者为中心的隔离护理计划工具。自该伦理指导工具发布以来（bit.ly/dementiatoolkit），已被下载超过6500次，并在国际上得到了传播。这些工作表在疫情爆发期间被用于支持护理和决策，也被积极地用于通过制定隔离护理计划为疫情爆发做准备。在疫情背景下，尤其是在长期护理等环境中，需要对伦理决策提供支持。未来的研究将评估该工具的实施情况及其对解决长期护理中医疗保健提供者道德困扰的影响。
