血液腫瘤病人的安寧緩和介入：待跨越的鴻溝與既有的嘗試

Palliative Care Intervention in Patients with Hematology Malignancies: Current Attempts and Gaps to be Bridged

近年來隨安寧緩和的介入漸趨早期化，收案對象也逐漸將範圍擴大，除固體腫瘤、慢性疾病，也納入末期衰弱老人、末期骨髓增生不良症候群、符合病人自主權利法第十四條第一項第二至五款條件病人、罕見疾病或其他預估生命受限者。然在血液腫瘤病人上，安寧緩和介入卻依舊是艱鉅的挑戰，肇因於其疾病臨床特性上快速且起伏跌宕劇烈，血液腫瘤科醫師治療上較少照會安寧，還有本身醫療系統的阻礙。

本篇文章旨在整理血液腫瘤病人的安寧緩和需求、其所遇到的困難與阻礙、並整理目前國際對於血液腫瘤病人已有的介入與經驗的整理，希以他山之石作為發想合適、可行的介入方式與時機，以及介入可能帶來的效益。

 

In recent years, there has been a trend towards early intervention in palliative care, and the scope of recipients has expanded. In addition to individuals with end-stage solid tumors and organ diseases, the recipients of palliative care now include terminal frail elderly, patients with myelodysplastic syndromes and other rare diseases, and individuals with limited life expectancy meeting the criteria outlined in Article 14, Paragraphs 1, Subparagraphs 2 to 5 of the Patient Right to Autonomy Act. However, in hematologic malignancies, palliative care interventions remain a significant challenge as hematologists consult palliative care less frequently due to the rapid and fluctuating changes along the clinical course of the disease and the obstacles within the medical system itself.

The article strives to identify the palliative care needs of patients with hematologic malignancies and the difficulties and obstacles they encounter; existing palliative interventions available for this group of patients around the globe have further been examined with the hope that lessons learned from others’ experiences can serve as inspirations for developing palliative interventions marked with better timing and greater benefits.