Preferencie pacientov v prospech „end-of-life care“ sú v US stále ignorované | Medicínske právo
              

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Preferencie pacientov v prospech „end-of-life care“ sú v US stále ignorované


 | 13.9.2013 | komentárov: 286

Projekt inštitútu „The Dartmouth Institute for Health Policy & Clinical Practise“ priniesol závery, že jeden zo štyroch pacientov Medicare s pokročilým štádiom rakoviny umiera v nemocnici na jednotke intenzívnej starostlivosti (intensive care units - ICUs), zatiaľ čo intenzita hospicovej starostlivosti na konci života narastá.

Obrazok Aktuálna správa s názvom „Trends in Cancer Care Near the End of Life“ v rámci projektu „Dartmouth Atlas Project“ (http://www.dartmouthatlas.org/pressroom/newsandpress.aspx) prezentuje zistenie, že napriek tomu, že využívanie starostlivosti prostredníctvom hospicov pre pacientov s Medicare (Medicare – systém zdravotného poistenia v US) s pokročilým štádiom rakoviny narastá, mnoho pacientov sa o takejto možnosti ani len nedozvie, a to až do momentu, pokiaľ doslova neležia na smrteľnej posteli s ostávajúcimi troma dňami života.

Paradoxne, v r. 2010 napriek nárastu vo využívaní hospicov, bolo viac pacientov ošetrovaných  jednotkou intenzívnej starostlivosti (intensive care units - ICUs) v ich poslednom mesiaci života, ako v období od r. 2003 do r. 2007.

Starostlivosť pre pacientov s rakovinou v pokročilom veku je často viac asociovaná s tým, kde žijú ako s ich preferovaním „end-of-life care“. Napriek tomu, že ich menej zomrelo v nemocnici v r. 2010 ako v rokoch 2003-2007, agresívne liečenie pokračuje až do konca života. Výsledky deklarujú, práve toľko pacientov bolo ochotných prijať život udržujúce úkony, akými sú endotracheálna intubácia, infúzia alebo cardiopulmonárna resuscitácia v poslednom mesiaci života pacienta alebo možnosť podstúpiť chemoterapiu počas posledných dvoch týždňoch života.

Nárast pacientov prijatých do hospicovej starostlivosti iba pár dní pred smrťou naznačuje, že takéto služby sú často poskytované už príliš neskoro na to, aby priniesli pacientovi väčší benefit,” tvrdí David C. Goodman z „Dartmouth Atlas Project“.

„A Dartmouth Atlas of Health Care Brief“ ďalej konštatuje, že pacienti s rakovinou chcú byť oboznámení s ich šancami a možnosťami liečenia a takisto podieľať sa v rozhodovaní o ich starostlivosti. To je obzvlášť pravdivé pre tých s pokročilým štádiom rakoviny, ktorí si potrebujú naplánovať ich posledné mesiace, resp. týždne života. Niektorí pacienti si zvolia možnosť pokračovať v agresívnej liečbe zameranej na predĺženie života ako to len bude možné, ale väčšina z nich preferuje podporné opatrenia, ktoré minimalizujú bolesť a počet dní strávených v nemocnici. Pacienti chcú vo všeobecnosti stráviť čo najviac času v v domácom prostredí, v kruhu rodiny a priateľov.

Plnohodnotnejšie diskusie s pacientmi v pokročilom štádiu rakoviny o ich prognóze a možnostiach ich starostlivosti, môžu viesť k lepšej kvalite ich života, než si mnohí vôbec uvedomujú.”


Spracoval:   Mgr. Lukáš Derco

Použité zdroje:
1. http://www.bioedge.org/index.php/bioethics/bioethics_article/10669
2. http://www.dartmouthatlas.org/downloads/press/Cancer_release_090413.pdf
3. http://www.dartmouthatlas.org/downloads/reports/Cancer_brief_090413.pdf


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