晚期肝癌病人之安寧緩和療護介入模式介紹

Introduction to Palliative Care Intervention Models for Patients with Advanced Hepatocellular Carcinoma

肝細胞癌（以下簡稱肝癌）在我國為發生率第五高、死亡率第二高之癌症，影響國民甚鉅。目前對於肝癌常用之分期為巴塞隆納肝癌分期，分作0, A, B, C, D期，在各分期表示肝癌有不同程度的生長與侵犯，各自造成病人不同程度的症狀。各分期所可使用之治療方式亦不盡相同，而對於治療方式的不確定性與伴隨治療所帶來的副作用，亦給病人帶來身體上與心靈上的痛苦。

對於晚期肝癌的病人，身體及心理上的症狀皆相當常見。於此，安寧緩和療護的介入將有助於病人面對身心的不適、決策、以及未來的規劃。本文目的旨在提供晚期肝癌腫瘤治療與安寧緩和療護的共同運作模式，集合安寧緩和療護當中的醫病共享決策、預立醫療照護諮商，歸納出癌症治療中最適切的安寧緩和療護。本文回藉由顧過去十年中數篇癌症中的安寧緩和療護、醫病共享決策之文獻，建構適合晚期肝癌病人之安寧緩和療護模式。於文獻回顧中，可發現晚期肝癌病人身心症狀之特殊性，有賴特殊的醫療照護模式介入。醫病共享決策中的三步驟對話模式，可協助晚期癌症病人在預立醫療照護諮商中尋找並確認自己所需之安寧緩和療護模式。而不同的醫療模式與不同的專業部門之間，則可依其性質提供不同的服務，並且跨領域整合以提供適宜之支持治療。安寧緩和療護有不同的提供模式，而跨領域整合各部門之資源時，在各醫療模式中，由不同部門的專家依醫病共享決策的模式建立適合病人之安寧緩和療護，可給予晚期肝癌病人所需之協助與照顧，提升病人生命末期之生活品質。

Of the leading cancers in Taiwan, hepatocellular carcinoma (HCC) ranks fifth and second respectively in terms of incidence and mortality. Based on the Barcelona-Clinic Liver Cancer (BCLC) staging system, severity of HCC begins with stage 0, followed by stages A to D. Patients with HCC at different stages therefore suffer from a variety of symptoms that require corresponding adjustments in treatment. For patients, this can bring uncertainty and unpredictable side effects, inflicting on them tremendous physical, mental, and spiritual agony.

Both physical and mental symptoms are common in late-stage HCC patients. Thus, the intervention of hospice and palliative care would help determine future medical plans to address different symptoms in the patients. This article introduces a cooperative model integrating late-stage HCC treatment and hospice and palliative care that incorporates shared decision making, advanced care planning, and hospice in cancer care. Different types of medical models play different roles in palliative and hospice care. Cross-disciplinary integration is essential in helping meet the needs of late-stage HCC patients and promote their end-of-life quality.