新冠肺炎流行期安寧緩和醫療所面臨的挑戰

Challenges of palliative care during the epidemic of COVID-19

在2019年冠狀病毒病或COVID-19大流行期間，為了防止醫院感染，安寧治療病房禁止家屬探望病人，但臨終病人除外。為了避免在醫院孤獨度過臨終時，許多有多種症狀需要醫療幫助的臨終病人會選擇接受家庭家治療。然而，居家安寧治療的資源相對不足。如果患者出現不適症狀，在家中很難得到很好的控制，家人也會面臨很大的護理壓力。此外，疫情期間，探視禁令不僅影響家屬陪伴患者的機會，也影響醫療團隊協助家屬的醫療決策討論和家屬預期的悲痛。由於COVID-19疫情這項禁止在安寧緩和病房探視患者的政策可能會在疫情嚴重時期持續下去，上述影響還將會持續發生。因此，應更迅速、更充分地調整居家安寧療護的資源，以滿足臨終患者的此類需求。本文建議醫療團隊應善用視訊，幫助住院患者及其家屬建立有效的情感聯繫，必要時召開家屬會議。此外，視訊設備還可用於遠程診療，幫助患者居家進行安寧緩和醫療治療，減輕不適症狀。另外在加護病房重症安寧及COVID-19重症患者面對無效醫療時，突發性重症患者家屬在做醫療決策兩難的困境，突顯預立醫療決定的重要性。

"During the severe epidemic of Coronavirus Disease 2019 or covid-19 pandemic and in order to prevent hospital infections, palliative care wards prohibit family members to visit patients except for dying patient. To avoid spending end-of-life dying alone in the hospital, many terminal patients with multiple symptoms requiring medical assistance would choose to have home palliative care. However, the resources for palliative care at home are relatively inadequate. If the patient has symptoms of discomfort, it is difficult to get good control at home, and family members will also face great care pressure. In addition, during the pandemic, the ban on visits not only affects the chances of family members to accompany the patient, but also affects the medical team helping family's medical decision-making discussion and the expected grief of the family. Since this policy of prohibiting visits to patients in palliative care wards may continue indefinitely, and the above-mentioned impact will continue. Therefore, home palliative care resources should be adjusted more quickly and adequately to meet such needs of patients at the end of life. It is suggested in this paper that the medical team should make good use of video equipment to help hospitalized patients and their families making effective emotional connections, and to hold family conferences when necessary. In addition, video equipment can also be used for remote diagnosis and treatment to help home palliative care of patients to reduce symptoms of discomfort. In addition, when critically ill patients in the intensive care unit and covid-19 critically ill patients face ineffective medical treatment, the family members of sudden critically ill patients are in a dilemma in making medical decisions, highlighting the importance of advance medical decisions."