Mooney-Doyle Kim, Mendola Annette, Naumann Wendy C, Svynarenko Radion, Lindley Lisa C
J Hosp Palliat Nurs. 2022 Sep 9. doi: 10.1097/NJH.0000000000000902.
The social determinants of comfort describe structural conditions that influence whether, to what degree, and in what forms comfort measures are offered to and accepted by people living with serious illness and their families. The notion of social determinants of comfort builds on the well-accepted concept of social determinants of health. Although some guiding palliative care documents begin to address this intersection, deeper understanding and exploration are needed. The goals of this article are to (1) describe and articulate the impact of structural and ecological factors on the comfort children and families can attain near the end of life; (2) describe how to address these factors to support children and families in attaining comfort, and maybe even flourish, at end of life; and (3) provide an agenda for research that addresses how palliative care research can advance health equity and how a focus on equity can advance palliative care science. A variety of inequities reinforce social vulnerability and disadvantage throughout the life span and can have profound effects on children, particularly children with serious illness or at the end of life. Ethical care for these children requires recognition of the social determinants of comfort.
舒适的社会决定因素描述了一些结构性条件，这些条件会影响针对重症患者及其家人提供舒适措施的方式、程度以及形式，以及他们是否接受这些措施。舒适的社会决定因素这一概念建立在已被广泛认可的健康的社会决定因素概念之上。尽管一些指导性的姑息治疗文件开始涉及这一交叉领域，但仍需要更深入的理解和探索。本文的目标是：（1）描述并阐明结构和生态因素对儿童及其家人在生命末期所能获得的舒适程度的影响；（2）描述如何应对这些因素，以支持儿童及其家人在生命末期获得舒适，甚至实现蓬勃发展；（3）提供一个研究议程，探讨姑息治疗研究如何促进健康公平，以及关注公平如何推动姑息治疗科学发展。在整个生命过程中，各种不平等加剧了社会脆弱性和劣势，对儿童，尤其是重症儿童或生命末期的儿童可能产生深远影响。对这些儿童进行符合伦理的照护需要认识到舒适的社会决定因素。
