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姑息治疗中的减药

Deprescription in Palliative Care.

作者信息

Cabrera Joana A, Mota Margarida, Pais Carmen, Morais Anabela

机构信息

Internal Medicine, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT.

Infectious Diseases, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT.

出版信息

Cureus. 2023 May 27;15(5):e39578. doi: 10.7759/cureus.39578. eCollection 2023 May.

DOI:10.7759/cureus.39578
PMID:37378207
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10292863/
Abstract

Individuals with limited life expectancy represent a significant proportion of healthcare consumers and are usually patients with multiple diseases and high levels of frailty. Polypharmacy and the prescription of long lists of drugs are frequent in patients with reduced life expectancy and often, as the patient's health status deteriorates, the list of drugs increases substantially as new medications are introduced to address new symptoms or complications. A key priority for healthcare professionals managing the care of these patients should be balancing the pharmacological approach to chronic diseases with the palliation of acute symptoms and complications. An important element of this process is to ensure that the benefit of any prescription decision outweighs potential risks. We reviewed the pros and cons of deprescribing drugs in individuals with limited life expectancy, how to identify the expected disease trajectory, which drugs are to be discontinued, identified some models trying to achieve rigorous deprescribing criteria, and the psychosocial effects of deprescribing in late phases of life. Deprescribing is not a one-time event but rather a continuous process that requires ongoing evaluation and monitoring. It is vital to continuously monitor and evaluate the pharmacological and non-pharmacological prescriptions for patients with chronic illnesses to align them with their goals of care and life expectancy.

摘要

预期寿命有限的人群在医疗保健消费者中占很大比例,他们通常患有多种疾病且身体极度虚弱。在预期寿命缩短的患者中,多重用药和开具一长串药物的处方很常见,而且随着患者健康状况恶化,由于引入新药物来处理新症状或并发症,药物清单往往会大幅增加。管理这些患者护理的医疗专业人员的一个关键优先事项应该是在对慢性病采取药物治疗方法与缓解急性症状和并发症之间取得平衡。这个过程的一个重要因素是确保任何处方决定的益处大于潜在风险。我们回顾了预期寿命有限的人群减药的利弊、如何确定预期的疾病轨迹、哪些药物应停用、确定了一些试图实现严格减药标准的模式以及减药在生命后期的心理社会影响。减药不是一次性事件,而是一个需要持续评估和监测的持续过程。持续监测和评估慢性病患者的药物和非药物处方,使其与他们的护理目标和预期寿命相一致至关重要。

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本文引用的文献

1
Deprescribing in Palliative Cancer Care.姑息性癌症护理中的减药
Life (Basel). 2022 Apr 20;12(5):613. doi: 10.3390/life12050613.
2
Palliative cardiovascular care: The right patient at the right time.舒缓心血管护理:在正确的时间为正确的患者提供服务。
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Polypharmacy in patients with advanced cancer and the role of medication discontinuation.晚期癌症患者的多种药物治疗及停药的作用。
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7
Recommendations to support deprescribing medications late in life.支持老年人减停药物的建议。
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8
Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial.在晚期、危及生命的疾病背景下停用他汀类药物治疗的安全性和益处:一项随机临床试验。
JAMA Intern Med. 2015 May;175(5):691-700. doi: 10.1001/jamainternmed.2015.0289.
9
Preventive medication use among persons with limited life expectancy.预期寿命有限者的预防性药物使用情况。
Prog Palliat Care. 2011 Jan;19(1):15-21. doi: 10.1179/174329111X576698.
10
Palliative care and type II diabetes: A need for new guidelines?姑息治疗与2型糖尿病:是否需要新指南?
Am J Hosp Palliat Care. 2010 Nov;27(7):444-5. doi: 10.1177/1049909110364222. Epub 2010 Apr 13.