Rudy Lauren, Lacroix Emilie
Department of Psychology, University of New Brunswick, Fredericton, NB, Canada.
Palliat Support Care. 2024 Feb 29:1-9. doi: 10.1017/S1478951523001402.
Substance use disorders (SUDs) are frequently encountered in hospice palliative care (HPC) and pose substantial quality-of-life issues for patients. However, most HPC physicians do not directly treat their patients' SUDs due to several institutional and personal barriers. This review will expand upon arguments for the integration of SUD treatment into HPC, will elucidate challenges for HPC providers, and will provide recommendations that address these challenges.
A thorough review of the literature was conducted. Arguments for the treatment of SUDs and recommendations for physicians have been synthesized and expanded upon.
Treating SUD in HPC has the potential to improve adherence to care, access to social support, and outcomes for pain, mental health, and physical health. Barriers to SUD treatment in HPC include difficulties with accurate assessment, insufficient training, attitudes and stigma, and compromised pain management regimens. Recommendations for physicians and training environments to address these challenges include developing familiarity with standardized SUD assessment tools and pain management practice guidelines, creating and disseminating visual campaigns to combat stigma, including SUD assessment and intervention as fellowship competencies, and obtaining additional training in psychosocial interventions.
By following these recommendations, HPC physicians can improve their competence and confidence in working with individuals with SUDs, which will help meet the pressing needs of this population.
物质使用障碍（SUDs）在临终关怀与姑息治疗（HPC）中经常出现，给患者带来了严重的生活质量问题。然而，由于一些机构和个人障碍，大多数HPC医生并不直接治疗患者的SUDs。本综述将详细阐述将SUD治疗纳入HPC的理由，阐明HPC提供者面临的挑战，并提供应对这些挑战的建议。
对文献进行了全面回顾。综合并扩展了关于SUD治疗的论据以及对医生的建议。
在HPC中治疗SUD有潜力提高对护理的依从性、获得社会支持的机会，并改善疼痛、心理健康和身体健康方面的结果。HPC中SUD治疗的障碍包括准确评估困难、培训不足、态度和耻辱感以及疼痛管理方案不完善。针对医生和培训环境应对这些挑战的建议包括熟悉标准化SUD评估工具和疼痛管理实践指南、开展并传播消除耻辱感的视觉宣传活动、将SUD评估和干预纳入专科培训能力范围，以及获得心理社会干预方面的额外培训。
通过遵循这些建议，HPC医生可以提高他们与患有SUDs的个体合作的能力和信心，这将有助于满足这一人群的迫切需求。
