Hospice and Palliative Medicine, Spectrum Health Medical Group, Grand Rapids, MI, USA.
University of Michigan School of Medicine, Ann Arbor, MI, USA.
Am J Hosp Palliat Care. 2023 Jun;40(6):597-600. doi: 10.1177/10499091221124110. Epub 2022 Aug 27.
Patients with Acute Myeloid Leukemia (AML) have a complex disease trajectory characterized by high symptom and psychosocial burden, a high rate of hospitalization and intensive care unit admission at the end-of-life (EOL), and frequent use of chemotherapy near the EOL. In addition, palliative and hospice care are underutilized in patients with AML despite their poor prognosis. Clinicians providing care to patients with end-stage AML frequently encounter multiple challenges, particularly surrounding the frequent administration of blood products near the EOL. We present a case of a patient with end-stage AML whose desire for transfusions causes significant patient and caregiver distress at the EOL. Balancing patient autonomy with the potentially inappropriate use of blood transfusions at the EOL and having good communication and collaboration among healthcare teams are important considerations when delivering optimal EOL care to patients with AML.
急性髓系白血病（AML）患者的疾病轨迹复杂，其特征是症状和心理社会负担高，临终时（EOL）的住院率和重症监护病房入院率高，以及临终时频繁使用化疗。此外，尽管 AML 患者预后不良，但姑息治疗和临终关怀的应用不足。为终末期 AML 患者提供护理的临床医生经常面临多种挑战，特别是在临终时频繁输注血液制品方面。我们介绍了一例终末期 AML 患者的病例，该患者在临终时对输血的渴望导致患者和护理人员严重痛苦。在临终时平衡患者自主性与潜在不适当的输血使用，并在医疗保健团队之间进行良好的沟通和协作，这是为 AML 患者提供最佳临终关怀的重要考虑因素。
