末期腎臟病及透析患者之安寧照護

Palliative Care for Patients with Endstage Renal Disease and Dialysis

台灣在2000年通過安寧緩和條例，並在2009年9月擴大照護對象，納入八大非癌症的末期病人，其中就包括末期腎臟病（endstagerenal disease, ESRD），其目的在於減少病人痛苦和避免無效侵入性的處置，如何將安寧緩和照護這個選項融入末期腎臟病的照護越來越受到重視。醫護人員應盡早與病患及家屬提及預立醫療自主計畫及死亡之議題，對於進入生命末期之透析病患漸進式的提供緩和醫療資訊並持續溝通繼續透析或終止透析之必要性，避免無效醫療，圓滿病患善終的自主心願，本篇文章將針對預立醫療指示及安寧緩和照護之推動、末期腎臟病及透析患者進入安寧照護之評估、透析護理人員於安寧照護的角色與功能、患者及家屬心理與心靈支持做探討，期望藉由此篇文章提供照護者參考。

Taiwan passed the palliative care regulations in 2000, and expanded the care objects to include eight categories involving non-cancer end-stage patients in September 2009, including end-stage renal disease (end-stage renal disease, ESRD). The purpose of palliative care is to reduce the suffering of patients and to avoid ineffective and invasive treatment. People pay more attention to integrate the option of palliative care into the endstage renal disease. Medical staff should mention the issue of advance medical self-planning and good death to ESRD patients and their families as soon as possible, and gradually provide palliative medical information and continue to communicate the necessity of continuing dialysis or terminating dialysis to patients entering the end of life. This article will focus on the promotion of advance directives and palliative care, the assessment of nursing care for end-stage renal disease and dialysis patients into palliative care, the role and function of dialysis nurses in palliative care, and the discussion on the psychological and spiritual support of patients and their families. We hope this article will serve as a reference for caregivers.