Kusamalira Antchito kwa Anthu Amene Ali ndi Khansa Yam'mimba: Kodi Mukufunikira Kudziwa Chiyani?
Ngakhale kulankhula mawu a chipatala ndi oopsa kwa aliyense amene ali ndi khansa. Mwamwayi, mawu akuti chipatala nthawi zina amalingana ndi kusiya, ngakhale kuli kutali ndi zimenezo.
Ndi khansara yamapapu, anthu ambiri amalephera kulandira phindu lachipatala mpaka masiku otsiriza a matenda awo. Pa nthawi yomweyi, anthu ena amasankha osadziwa zachipatala kuti pangakhale njira zatsopano zothandizira khansa yapakhungu yapamwamba .
Kodi mukuyenera kudziwa chiyani kuti mukhale ndi mphamvu pakupanga chisankho chokhudza hospice; onse kuonetsetsa kuti simuli "kulumphira mfuti" ngati chithandizo chamakono chikhoza kupititsa patsogolo moyo ndi zotsatira zochepa, ndikusankha chithandizochi mofulumira kuti mutha kulandira phindu?
N'chifukwa Chiyani Ndikofunika Kuyankhula Za Hospice Pamene Mukumva Zabwino?
Pakati pa anthu omwe ali ndi khansara yamapapu , tikudziwa kuti chipatala chimagwiritsidwa ntchito mosavuta. Tikudziwanso kuti anthu ambiri amasankha chipatala kumapeto kwa moyo wawo-masiku otsiriza komanso mwinamwake masabata-akusowa phindu lalikulu pulogalamuyi.
Pa nthawi yomweyi, chithandizo cha khansa ya m'mapapo chasintha kwambiri m'zaka zaposachedwapa, ndipo pakhala kusintha kosintha kwa kayendetsedwe ka ndondomeko ya matendawa. Mankhwala omwe sanamve zaka khumi zapitazo tsopano akuthandiza anthu ena kukhala ndi moyo nthawi yaitali kuposa kale; ngakhale khansara ya mapapo 4.
Pakati pa kusintha kumeneku, mungadziwe bwanji kuti ndi nthawi yosankha odwala? Tiyeni tiyambe mwakulankhula za momwe hospice alili ndi zomwe zingatanthauze kwa inu. Ndiye tiyeni tiyankhule za momwe tingapangire chisankho chopweteka ichi.
Mwatsoka, maphunziro amatiuza kuti madokotala ambiri alephera kubweretsa chisamaliro cha odwala. Izi zikutanthawuza kuti inu ndi banja lanu mungafunikire kukambirana ndi dokotala wanu, ndipo makamaka musanayambe kufunika.
Kuphatikiza pa kukhala ndi mwayi wopindula ndi maulendo odwala, maphunziro a 2017 anapeza kuti kukambirana koyambirira kwa hospice ndi anthu omwe ali ndi khansa yamapapu kunachititsa kuti chithandizo chamankhwala chisawonongeke kumapeto kwa moyo. (Panalibe kusiyana pakati pa anthu omwe anali ndi nkhanza kumapeto kwa moyo ndi omwe sanatero.) Phunziro lina, mamembala a anthu omwe ali ndi khansara yamapapu omwe anali ndi chiwerengero cha anthu odwala matenda opatsirana kuchipatala anali nako kuzindikira bwino mapeto a moyo umasamalira wokondedwa wawo kuposa iwo omwe sanatero.
Kodi Chipatala cha Khansa Yam'mimba N'chiyani?
Mmalo mwa "malo," ngakhale pali malo omwe amapereka chisamaliro kuchipatala, chipatala chiri ndi filosofi yambiri. Amatanthauzidwa ngati chizoloŵezi chomwe chimapereka chisamaliro chaumunthu ndi chisamaliro kwa anthu omwe ali m'magulu otsiriza a matenda osachiritsika kuti akhale ndi moyo mokwanira komanso moyenera.
Cholinga cha kuchipatala ndicho kuchiza munthu osati matendawa m'njira yomwe sichifulumira kapena kuimitsa imfa.
Anthu ambiri akusokonezeka pakati pa chisamaliro chachipatala ndi chisamaliro cholera bwino chifukwa zonse zimaganizira zozizwitsa komanso zimapereka chithandizo chamthupi, chakuthupi ndi chauzimu. Kusiyanitsa kwakukulu ndiko kuti chisamaliro chosamalidwa chingagwiritsidwe ntchito nthawi iliyonse, ngakhale khansara yochiritsidwa, koma chisamaliro cha odwala chimapangidwa kwa anthu m'miyezi 6 yapitali ya moyo.
Pali nthano zambiri zokhudza chisamaliro cha odwala , kuphatikizapo nthano yakuti posankha chisamaliro cha odwala "mukusiya." Izi siziri kutali ndi choonadi, ndipo posankha anthu ochiritsira nthawi zambiri amapanga chisankho chokhalitsa masiku awo otsiriza mwaulemu ndi chitonthozo.
Osati onse ogwira ntchito kuchipatala ndi ofanana, ndipo pali magulu anayi osiyana siyana a chithandizo cha odwala omwe ali ndi malingaliro a Medicare. Izi zikuphatikizapo:
- Mzere 1: Chisamaliro cha nthawi zonse. Kusamalidwa kumeneku kumapereka chithandizo chachikulu kuchokera kuchipatala kuti zithandize.
- Mzere wachiwiri: Kusamalila kwanu pakhomo. Kusamalira kunyumba nthawi zonse kumakhala nthawi yayitali yomwe imagwiritsidwa ntchito pakakhala ululu kapenanso kupuma pang'ono. Chisamaliro chimayesedwanso tsiku ndi tsiku ndipo namwino kapena chithandizo chamankhwala chapakhomo chimapezeka maola 8 mpaka 24 pa tsiku.
- Mlingo wachitatu: Chisamaliro chachilendo cha ana omwe akudwala. Utumikiwu ndi wofanana ndi kusamalidwa kwapakhomo komabe anthu omwe amasamalira chithandizo cham'chipatala.
- Mlingo wachinayi: Kusamalidwa. Kusamalidwa ndizomwe munthu angapemphere kwa nthawi yayitali kwa omwe akulandira chithandizo cha 1 chipatala, koma kusamalira nkhawa kumabweretsa mavuto ndipo banja limasowa pang'ono. Kawirikawiri pali malire a masiku asanu pa chisamaliro ichi.
Kodi Ndi Zipangizo Ziti Zoperekedwa ndi Hospice?
Ziri zosavuta kumvetsetsa zomwe zimaperekedwa ndi hospice ngati mumvetsetsa kuti chipatalachi chinapangidwa kuti chisamalire munthu, mwakuthupi, komanso mwauzimu, osati munthu yekhayo amene akufa, koma banja lonse. Zina mwazinthu zoperekedwa ndi hospice zikuphatikizapo:
- Chizindikiro chachizindikiro: Gulu lanu lothandizira anthu ogwira ntchito kuchipatala limapereka mankhwala ndi chithandizo chothandiza ndi zizindikiro monga ululu , kupuma pang'ono , kunyoza kapena kusanza, ndi zizindikiro zina za khansa kapena zotsatira za mankhwala omwe mwakhala nawo.
- Kusamalira odwala : Anthu ambiri amatha kusankha kunyumba kapena kuchipatala chithandizo cha kuchipatala. Kwa omwe amasankha chisamaliro chapakhomo, kusamalidwa bwino m'mimba (kwa masiku asanu ndi asanu) kumaperekedwa pamene mamembala akudandaula kapena akusowa chifukwa.
- Chisamaliro chauzimu: Gulu lanu losamalira odwala limaphatikizapo atsogoleri achipembedzo omwe angakuthandizeni ndi mafunso ovuta kumapeto kwa moyo. Kusamalidwa kumeneku kwapangidwira zosowa zanu zomwe sizikulimbikitsanso kapena kupatulapo chizoloŵezi china chachipembedzo china.
- Kufikira 24/7: Mutha kulankhulana ndi gulu lanu losamalira odwala nthawi iliyonse yamasana kapena usiku ndi mafunso aliwonse kapena nkhawa zomwe muli nazo.
- Thandizo la banja: Gulu lachipatala ndilo banja, ndipo kuwonjezera pa kuthandiza banja lanu kumvetsa zomwe mukukumana nazo ndi mankhwala, thandizo limaperekedwa kwa mafunso awo ndi mavuto a maganizo. Misonkhano ya banja ikhoza kuchitidwa kuti mamembala a m'banja azigawana zomwe akumva, ndi kuyankhula za mantha awo ndi nkhawa zawo.
- Chisamaliro chachisamaliro : Kwa nthawi ya chaka chonse pambuyo pa imfa, hospice imapereka chithandizo kwa anthu apabanja omwe apulumuka. Izi zingaphatikizepo uphungu kapena atsogoleri payekha kapena pafoni.
Kodi Mungapitirize Kulandira Chithandizo Mukamawasamalira?
Anthu ambiri amachita mantha posankha chipatala chifukwa amakhulupirira kuti mankhwalawa amasiya kwathunthu. Izi si zoona. Posankha odwala omwe mumapanga chisankho chotsutsana ndi khansa yanu yamapapu, koma izi sizikutanthauza kuti mankhwala onse amatha. Kusiyanitsa ndiko kuti mankhwala amathandizira kuwonetsetsa kwa zizindikiro ndikuwongolera umoyo wanu m'malo mochiza khansa yokha.
Omwe amathandiza odwala omwe ali ndi matenda osiyanasiyana ali ndi zifukwa zosiyana pa zomwe zimapanga chithandizo chamankhwala. Mwachitsanzo, kugwiritsira ntchito tizilombo toyambitsa matenda kungatipangitse kuti tisamalire kuti tizilombo toyang'anira matenda. Ndi khansara yamapapu, makamaka mapulogalamu othandizira odwala amatha kukhala osiyana ndi omwe amavomerezedwa monga kuyendetsa bwino mapulusa omwe ali ndi khansa).
Mapulogalamu ena angaganizire kukhetsa madzi kapena kukhazikitsa njira zowonongeka zomwe zimapangitsa kuti mpweya usafulumire. Chitsanzo china chingakhale kupweteka kapena kupweteka chifukwa cha metastases ya mafupa. Nthawi zina amagwiritsidwa ntchito pofuna kuchepetsa kupweteka, koma mwina kapena sungaganizidwe ngati mtundu wa "mankhwala othandiza" malinga ndi bungwe lapadera lachipatala. Kuganiziranso kwina kungakhale kugwiritsidwa ntchito kwa madzi am'mimba ngati munthu ali ndi chidziwitso chifukwa cha kuchepa kwa madzi.
Inde, mankhwala omwe makamaka amachititsa ululu, kupuma, ndi kusungunuka zimaphimbidwa, kuti cholinga chanu chikulitse umoyo wanu.
Kodi Ndi Nthawi Yanji Imene Muyenera Kusamalirako Ndi Khansa Yam'mimba?
Kawirikawiri chipatala chimalimbikitsidwa pamene zoopsa ndi zotsatira za mankhwala owonjezera zidzapindulitsa kwambiri. Mosakayikira izi ndizomwe munthu aliyense amafunika kudziyeza, ndipo yankho likhoza kusiyana pakati pa anthu osiyanasiyana. Palibe chabwino ndi cholakwika pa spectrum iyi; Chosankha chomwe chili chabwino kwa inu ndi banja lanu.
Ndikofunika kuzindikira kuti pakupita patsogolo pa chithandizo cha kansa ya m'mapapo m'zaka zaposachedwapa, ngakhale kusintha kumene kunachitika pakati pa 2015 ndi 2017, yankho likhoza kukhala losiyana kwambiri ndi zaka zingapo zapitazo.
Njira Zatsopano Zomwe Mungaganizire Musanayambe Kusankha Chipatala
M'mbuyomu, khansara yamapapu yopanda mphamvu inali ndi zochepa chabe. Thandizo la ma ARV pakakhala khansara yamapapu yapamwamba kwambiri ndilopangitsa kuti anthu azivutika komanso azivutika. Nthawi zambiri amasiya mankhwala a chemotherapy okha ngati njira yomwe ingapangitse moyo; ndipo kuyeza kuopsa ndi phindu la chemotherapy regimens ndilo funso lalikulu.
Izi zasintha kwambiri ndi njira zatsopano zothandizira monga chithandizo chochiritsidwa ndi immunotherapy. Ndikofunika kuti aliyense yemwe ali ndi khansa ya m'mapapo yopanda maselo ali ndi majekesi (kuyesera kwa jini) zomwe zimachitidwa pamimba, osati onse omwe akuyenera kulandira mankhwalawa akudziwa kuti alipo. Ngati kusintha kwasinthika monga kusintha kwa EGFR , rearrangement ALK , kapena rearrangement ya ROS1 ya gene .
Immunotherapy ndi njira ina yomwe nthawi zina imakhala yogwira mtima (komanso mochititsa chidwi kwa anthu ena) ndi khansa ya m'mapapo yapamwamba. Mankhwalawa ndi othandiza kwambiri ngati muli ndi PD-L1 kuyezetsa magazi. Ngakhale mankhwala osokoneza bongo samagwira ntchito kwa aliyense, akhoza, kwa anthu ena, amachititsa kuti azikhala ndi mphamvu yothetsera khansa.
Mankhwala ochiritsidwa komanso mankhwala osokoneza bongo amakhala opanda mavuto, koma nthawi zambiri amalekerera bwino kusiyana ndi mankhwala a chibadwa.
Ndikofunika kuzindikira kuti, ngakhale chithandizo ndi odwala, immunotherapy, kapena chemotherapy angapangitse moyo, anthu ena amasankha kuti asapitirire kuchipatala. Kupitila kupyolera mu khansa ya mtundu uliwonse si kophweka kwa wina aliyense, ndipo anthu ena akumangotopa kwambiri kuti asapitirire mankhwala ena onse Pakupanga kusankha kwanu muyenera kulemekeza zofuna zanu nokha ndikusankha zomwe zili zabwino kwa inu, patali pamene mukudziwa bwino zomwe mungasankhe. Kuonjezera apo, ngakhale mankhwalawa angakhale othandiza nthawi zina, mapeto ambiri mankhwala amasiya kugwira ntchito, ndipo chisankho chokhudza hospice chidzayang'anizana.
Popeza kusankha chisamaliro ndikosankha kusankha kusiya chithandizo chamankhwala, tengani kamphindi kukambirana ndi banja lanu zokhudzana ndi nkhaniyi musanayambe chithandizo cha khansa .
Mafunso Ofunsani Musanayambe Kusankha Chipatala
Chisankho chofuna kusankha odwala amatha kukhala chodabwitsa, koma chingathandize kufunsa mafunso angapo:
- Kodi pali njira zotsata zotsalira? Pofunsa funsoli mungafune kufunsa mwatsatanetsatane za mankhwala a chemotherapy, njira zothandizira, njira zochizira matenda, komanso kuthekera kwa mayesero alionse omwe mungakhale nawo.
- Kodi umoyo wanu ndi wotani lero? Kodi mukufuna kuti moyo wanu ukhale wotani? Kodi mankhwala ena amatha kuchepetsa moyo wanu patsogolo?
- Kodi mwakhala mukuyang'anitsitsa? Kusamalana ndi chisamaliro chomwe chimakhudza thanzi lanu, malingaliro, ndi uzimu ngakhale ngati cholinga chanu chiri chithandizo.
- Kodi banja lanu limamva bwanji ponena za chisankho chanu?
- Kodi chisamaliro cha hospice chimayang'aniridwa ndi inshuwaransi ya mankhwala kapena hospice Medicare yopindula ?
Tengani kamphindi kuti muwerenge ubwino ndi kuipa kwa chisamaliro cha odwala . Nthawi zina kuziwona izi papepala lakuda ndi zoyera zingapangitse kusankha kwanu kumveka bwino.
Mmene Mungapezere Thandizo Labwino Kwambiri Popereka Mavuto Achipatala
Kukhalapo kwa chisamaliro cha odwala kumasiyana malinga ndi kumene mukukhala, ndipo nthawi zambiri kumakhala kosavuta ngati mumakhala kumidzi kusiyana ndi kumidzi. Choyamba ndi kusankha ngati mukufuna kukhala ndi chipatala chakumudzi kapena ngati mukufuna kukhala m'chipatala. Palibe chisankho chabwino, ndipo chisankho chabwino ndi chomwe inu ndi banja lanu mumamva kuti ndi choyenera kwa inu.
Madera ambiri ali ndi othandizira odwala mmodzi, choncho muyenera kusankha chomwe chikugwirizana ndi zosowa zanu. Wachikulire wanu wa oncologist ndi oncology namwino angathandize. Ngati mutakhala nawo m'gulu lanu lothandizira khansa la m'mapapo, mukhoza kupempha malangizo kuchokera kwa anthuwa. Palinso mabungwe a boma ndi a mayiko, monga bungwe lanu la hospice, omwe mungathe kufunsa mafunso.
Bwanji Ngati Mukusintha Maganizo Anu?
Ndikofunika kwa aliyense amene amasankha chisamaliro cha odwala kuti adziwe kuti ndibwino kusintha maganizo anu. Ngati mukuganiza kuti mukufuna kuti mupitirize kuchiza khansa yogwira ntchito, kapena ngati mankhwala atsopano akuchiza kansa ya m'mapapo ndivomerezedwa ndipo mungasankhe kuchoka kuchipatala.
Mawu Ochokera
Kuyankhula za hospice ndi kukambirana kovuta kwa anthu omwe ali ndi khansara ndi awo oncologist ofanana. Tsoka ilo, tikudziwa kuti ndi anthu ochepa okha omwe amasankha kuchipatala kufikira atatsala pang'ono kufa, ndipo amasowa ntchito zambiri zabwino zomwe odwala angapereke. Chisankho chokhudza matenda opatsirana khansa ya m'mapapo chimaphatikizapo mafunso ndi malingaliro ambiri kuposa kale, chifukwa cha kupita patsogolo pa chithandizo cha kansa ya m'mapapo yapamwamba monga chithandizo chamankhwala ndi chithandizo cha immunotherapy.
Palibe anthu awiri kapena khansa ziwiri zofanana, ndipo palibe amene angakupangire chisankho chofunikira. Ndikofunika kumvetsa zonse zomwe mungasankhe, ndiyeno kusankha kusankha zomwe zimafuna zosowa zanu komanso za banja lanu. Izi zati, maphunziro ambiri adapeza kuti mabanja a anthu omwe ali ndi khansara yamapapu amakhulupirira kuti moyo wa wokondedwa wawo unali wabwino kwambiri pamene chisamaliro cha chipatala chinasankhidwiratu kale osati pamapeto pake.
> Zotsatira:
> Ersek, M., Miller, S., Wagner, T. et al. Kugwirizana pakati pa Chisamaliro Chokwiya ndi Mabanja Operewera Kufufuza kwa Mapeto a Moyo Wosamalira Ankhondo Omwe Akulimbana ndi Nkhondo Yomwe Sali yaing'ono Imene Imfa M'madera Omwe Akugwira Ntchito. Khansa . 2017. 123 (1): 3186-3194.
> Schuler, M., Joyce, N., Huskamp, H., Lamont, E., ndi L. Hatfield. Mankhwala Opindula ndi Maphunziro Aakulu a Khansa Yapamwamba Kwambiri Zochitika Zosamalidwa Zomwe Zilipo Kuchokera Kulimbana ndi Kufa. Health Affairs . 2017. 36 (7): 1193-1200.
> Wright, A., Keating, N., Avanian, J. et al. Zotsatira za Banja pa Thandizo Labwino la Khansa Chakumapeto kwa Moyo. JAMA . 2016. 315 (3): 284-92.
> Yoo, S., Keam, B., Kim, M. et al. Zotsatira za Kukambirana kwa Achipatala pa Kuchitira Nkhanza Khansa ya M'mimba. Kafukufuku ndi Chithandizo cha Khansa . 2017 July 14. (Epub patsogolo pa kusindikiza).