生命与死亡:一项多中心研究评估了心脏病学家对与Fontan患者和家属进行困难对话的方法
Seohyuk Lee1,2, Rahul H Rathod3, Anne Marie Valente3,4
1Department of Pediatrics and Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, CT, USA.
Pediatric cardiology
|August 20, 2024
概括
心脏病专家愿意与Fontan患者及其家人讨论预后. 然而,近一半的患者面临障碍,主要是患者相关的问题,阻碍了这些关键的对话.
科学领域:
- 心脏病学 心脏病学
- 儿童心脏病学 儿童心脏病学
- 遗传性心脏病是一种先天性心脏病.
背景情况:
- 芬顿患者需要终身门诊心脏病护理.
- 丰田人口老龄化 丰田人口老龄化 丰田人口老龄化 丰田人口老龄化 丰田人口老龄化 丰田人口老龄化 丰田人口老龄化 丰田人口老龄化 丰田人口老龄化
- 预后和护理讨论的目标是必不可少的,但具有挑战性.
研究的目的:
- 评估心脏病学家对Fontan患者和护理人员风险咨询的态度.
- 在讨论预后和不良事件风险时识别感知障碍.
- 在这个人群中为促进困难对话提供信息的策略.
主要方法:
- 一项新的调查分发给照顾Fontan患者的心脏病专家,年龄超过10岁.
- 收集的数据包括医生人口统计,风险讨论的时间和障碍.
- 障碍物从叙事评论中进行了主题分析.
主要成果:
- 40名心脏病学家对155名Fontan患者进行了调查 (平均年龄为21.2岁).
- 大多数心脏病专家认为讨论是及时的,患者/家属已经准备好了.
- 42%的人报告有重大障碍,主要与患者相关 (认知/心理健康).
- 心脏病专家更喜欢与护理人员讨论风险,比患者 (平均年龄17岁) 更早 (患者平均年龄9岁).
结论:
- 经验丰富的心脏病专家愿意参与困难的预后讨论.
- 与患者相关的因素是有效风险咨询的最重要障碍.
- 促进这些对话对于青少年和年轻成人幸存者至关重要.
相关概念视频
01:27Ethical Issues
Nurses are essential in patient care, upholding the ethical principles of their profession and effectively navigating ethical dilemmas. Neglecting ethical issues can lead to inadequate patient care, compromised therapeutic relationships, and moral distress among healthcare workers.
Ethical Concerns in Healthcare:
Ethical Concerns in Healthcare:
01:27Coronary Artery Disease V: Interprofessional Care
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
01:22Heart Failure VI: Adjunct Therapies
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
01:30Cardiomyopathy II: Dilated Cardiomyopathy
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
01:29Cardiomyopathy V: Interprofessional Care
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...