安寧緩和醫療於末期腎病透析老年病人之應用

Palliative Care in Elderly with End-Stage Renal Disease Under Dialysis

當今許多醫療實證研究均指出安寧緩和療護可以提昇疾病末期病人之生活品質。但國內安寧緩和療護於末期腎病透析病人之應用尚未發展。臨床上所見末期腎病透析病人，尤其老人多重器官逐漸衰竭，更接近生命末期；故本文擬藉由臨床經驗與文獻查證，剖析末期腎病透析老年病人對安寧緩和療護之照護需求，內文包括末期症狀處理，以及社區末期腎病透析病人之安寧緩和療護，期能及早開啟醫療人員與透析病人和家屬有關病情治療的對話，於溝通過程中致力於尊重病人的自主性，並建立良好信任的醫病關係下強化透析病人預立醫療指示的動機。建議未來著手建立撤除透析後相關照護指引，裨於推展末期腎病透析病人之安寧緩和療護，來提昇生命末期的照護品質，特別是讓老年病人可以完成善終。

There are increasing evidences that palliative care can improve the quality-of-life of patients with end-stage disease. However, there is still no development of palliative care guideline for patients with end-stage renal disease under dialysis in Taiwan. In clinical practice, the elderly under dialysis especially suffer from multiple-organ failure and near the end-of-life. The article integrates literature reviews and clinical experiences to explore the needs of palliative care in the elderly with end-stage renal disease under dialysis. The content includes managing end-stage symptoms, promoting the community-based palliative care, attending the early dialogue among healthcare providers, patients and family about treatment, offering efforts to respect the patients’ autonomy in communications, and increasing motivation in completing advanced care planning based on the trust relationship between medical team and patients. For enhancing the care quality of end-of-life toward a peaceful death, we suggest the establishment of caring guidelines on dialysis withdrawal in the future, which may contribute to the promotion of palliative care in patients with end-stage renal disease under dialysis.