Tang Grace H, Thachil Jecko, Bowman Mackenzie, Bekdache Carine, James Paula D, Sholzberg Michelle
Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada.
Department of Hematology, Manchester University Hospitals, Manchester, UK.
Expert Rev Hematol. 2023 Jul-Dec;16(9):641-649. doi: 10.1080/17474086.2023.2243386. Epub 2023 Aug 15.
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.
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.
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.
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。
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。
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。