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血管性血友病的以患者为中心的护理:我们做到了吗?

Patient-centered care in von Willebrand disease: are we there yet?

作者信息

Tang Grace H, Thachil Jecko, Bowman Mackenzie, Bekdache Carine, James Paula D, Sholzberg Michelle

机构信息

Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada.

Department of Hematology, Manchester University Hospitals, Manchester, UK.

出版信息

Expert Rev Hematol. 2023 Jul-Dec;16(9):641-649. doi: 10.1080/17474086.2023.2243386. Epub 2023 Aug 15.

DOI:10.1080/17474086.2023.2243386
PMID:37581602
Abstract

INTRODUCTION

Von Willebrand Disease is the most common inherited bleeding disorder. Paradoxically, affected individuals are often misdiagnosed and experience substantial diagnostic delay. There are sex-specific health disparities in VWD rooted in the stigmatization of vaginal bleeding, which leads to symptom dismissal, lack of timely access to care and lower health-related quality of life.

AREAS COVERED

Following the core elements of patient-centered care - respect for patient preferences, values, and needs, we describe the current state of VWD care. Challenges of diagnostic delay, serial misrecognition of abnormal bleeding, and symptom dismissal are barriers that disproportionately affect women with VWD. These negative effects are further amplified in individuals living in low- and middle-income countries. We describe the importance of coordinated multidisciplinary care, as well as the need for patient education and empowered self-advocacy.

EXPERT OPINION

While tremendous work has been done to improve the diagnosis and management of VWD, timely and high-quality research is urgently needed to address care gaps. Systemic changes such as resource investment, dedicated research funding for novel treatment modalities, and effective knowledge translation strategies to address structural barriers are needed to facilitate effective patient-centered care for VWD.

摘要

引言

血管性血友病是最常见的遗传性出血性疾病。矛盾的是,受影响的个体常常被误诊,且诊断延迟时间较长。血管性血友病存在基于阴道出血污名化的性别特异性健康差异,这导致症状被忽视、无法及时获得治疗以及与健康相关的生活质量较低。

涵盖领域

遵循以患者为中心的医疗核心要素——尊重患者的偏好、价值观和需求,我们描述了血管性血友病的当前治疗状况。诊断延迟、对异常出血的多次误认以及症状被忽视等挑战是对血管性血友病女性影响尤为严重的障碍。这些负面影响在低收入和中等收入国家的人群中进一步加剧。我们阐述了多学科协调护理的重要性,以及患者教育和增强自我维权能力的必要性。

专家意见

尽管在改善血管性血友病的诊断和管理方面已经做了大量工作,但迫切需要及时开展高质量研究以填补护理空白。需要进行系统性变革,如资源投入、为新型治疗方式提供专门的研究资金,以及采取有效的知识转化策略来消除结构性障碍,以促进针对血管性血友病患者的有效以患者为中心的护理。

相似文献

1
Patient-centered care in von Willebrand disease: are we there yet?血管性血友病的以患者为中心的护理:我们做到了吗?
Expert Rev Hematol. 2023 Jul-Dec;16(9):641-649. doi: 10.1080/17474086.2023.2243386. Epub 2023 Aug 15.
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Gastrointestinal bleeding in von Willebrand patients: special diagnostic and management considerations.血管性血友病患者的胃肠道出血:特殊诊断与管理考量
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What have we learned about the patient's experience of von Willebrand disease? A focus on women.我们从关于血管性血友病患者体验的研究中学到了什么?关注女性。
Hematology Am Soc Hematol Educ Program. 2022 Dec 9;2022(1):631-636. doi: 10.1182/hematology.2022000391.
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A need to increase von Willebrand disease awareness: vwdtest.com - A global initiative to help address this gap.提高对血管性血友病的认识的必要性:vwdtest.com——一项旨在填补这一空白的全球倡议。
Blood Rev. 2023 Mar;58:101018. doi: 10.1016/j.blre.2022.101018. Epub 2022 Oct 1.
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von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA).血管性血友病(VWD):基于证据的诊断和管理指南,美国国立心肺血液研究所(NHLBI)专家小组报告
Haemophilia. 2008 Mar;14(2):171-232. doi: 10.1111/j.1365-2516.2007.01643.x.
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Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research priorities for mucocutaneous bleeding disorders.为社区主导的遗传性出血性疾病国家研究蓝图奠定基础:黏膜出血性疾病研究重点。
Expert Rev Hematol. 2023 Mar;16(sup1):39-54. doi: 10.1080/17474086.2023.2171983.
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Von Willebrand Disease: Gaining a global perspective.血管性血友病:获得全球视角。
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Von Willebrand Disease-Specific Aspects in Women.女性特发性血管性血友病的相关问题。
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An expert consensus to define how higher standards of equitable care for von Willebrand disease can be achieved in the UK and Republic of Ireland.一份专家共识,旨在明确如何在英国和爱尔兰共和国实现更高标准的血管性血友病公平护理。
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von Willebrand Disease: Diagnostic Strategies and Treatment Options.血管性血友病:诊断策略与治疗选择
Pediatr Clin North Am. 2018 Jun;65(3):527-541. doi: 10.1016/j.pcl.2018.02.004.

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