Nolley Eric, Morrell Matt
Division of Pulmonary and Critical Care Medicine, Department of Medicine, John's Hopkins University, Baltimore, MD, USA.
Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
J Thorac Dis. 2021 Nov;13(11):6737-6746. doi: 10.21037/jtd-2021-27.
Lung transplantation confers meaningful benefit for patients by extending life and improving quality of life. Palliative care is a medical specialty that likewise aims to improve the quality of life of patients enduring serious illness and their caregivers. Yet, while transplant candidates and recipients face serious illness they rarely receive palliative care, even at end of life. While limited palliative care utilization is likely multifactorial, one key reason is a limited understanding of the specialty of palliative care and evidence for palliative interventions. In this review, we address this key barrier by discussing in depth what the specialty of palliative care is and provides to patients and their caregivers. We then discuss the growing evidence for palliative care interventions to improve quality of life and reduce symptom burdens in patients with malignancy including those undergoing bone marrow transplantation and patients with chronic organ failure. We then consider what palliative care needs exist across pre and post transplantation based on studies of palliative care needs of patients with end stage lung disease, studies of quality of life after lung transplantation, and limited studies of palliative care utilization pre and post lung transplantation. Finally, we consider different models of palliative care and discuss how palliative care might optimally be incorporated in lung transplantation using a longitudinal, integrated approach to palliative care.
肺移植通过延长生命和提高生活质量为患者带来了显著益处。姑息治疗是一门医学专业，同样旨在提高患有严重疾病的患者及其护理人员的生活质量。然而，尽管肺移植候选者和接受者面临严重疾病，但他们很少接受姑息治疗，即使在生命末期也是如此。虽然姑息治疗利用率有限可能是多因素造成的，但一个关键原因是对姑息治疗专业以及姑息治疗干预证据的理解有限。在本综述中，我们通过深入讨论姑息治疗专业是什么以及它能为患者及其护理人员提供什么来解决这一关键障碍。然后，我们讨论了越来越多的证据表明，姑息治疗干预可改善恶性肿瘤患者（包括接受骨髓移植的患者和慢性器官衰竭患者）的生活质量并减轻症状负担。接着，基于对终末期肺病患者姑息治疗需求的研究、肺移植后生活质量的研究以及肺移植前后姑息治疗利用率的有限研究，我们考虑了移植前后存在哪些姑息治疗需求。最后，我们考虑不同的姑息治疗模式，并讨论如何采用纵向、综合的姑息治疗方法将姑息治疗最佳地纳入肺移植中。
