The challenges of symptom management for patients with multimorbidity in research and practice: a thematic review.
The challenges of symptom management for patients with multimorbidity in research and practice: a thematic review.
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研究和实践中多病患者症状管理的挑战：专题回顾。
DOI：
10.1080/09699260.2016.1192320
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发表时间：
2016
影响因子：
1.7
通讯作者：
Ritchie,ChristineS
中科院分区：
文献类型：
--
作者：
Petrillo,LauraA;Ritchie,ChristineS
简介：多重发病率，即多种共存疾病或病症的存在，困扰着大多数老年人，并与死亡率和医疗保健利用率的增加有关。此外，多重疾病会对生活质量产生负面影响并增加症状负担。然而，关于如何最好地管理多病患者的症状，缺乏证据。方法：我们对多病症状管理方法进行了专题回顾。结果：该领域的研究因多病定义不一致和结果测量方面的挑战而受到阻碍。对癌症等特定疾病状态的症状管理策略的研究通常会排除病情复杂的患者。在缺乏证据的情况下，美国老年医学会关于患有多种疾病的成年人的护理建议为临床医生提供了一个有用的起点。我们通过一个案例来展示如何根据多病患者的症状管理情况调整 AGS 建议。我们还提出了对未来研究方向的建议。讨论：多发病是我们医疗保健系统中一个极其常见且被忽视的问题，并且随着患者寿命的延长并有机会承受更大的慢性病负担，其相关性只会增加。针对多种疾病患者的综合方法包括关注患者的偏好，仔细解释现有证据（包括益处和潜在危害），并批判性地思考任何治疗的负担。花时间了解患者的目标和偏好，并告知患者其预后（如果他们想知道），这在与多病患者讨论症状管理时尤为重要。
Introduction:Multimorbidity, the presence of multiple coexisting diseases or conditions, afflicts the majority of older adults, and is associated with increased mortality and healthcare utilization. In addition, multimorbidity negatively impacts quality of life and increases symptom burden. Yet, there is a dearth of evidence on how to best manage symptoms in patients with multimorbidity.Methods:We conducted a thematic review of approaches to symptom management in multimorbidity.Results:Research in this area has been hampered by inconsistent definitions of multimorbidity and challenges in outcome measurement. Investigations of symptom management strategies in specific disease states, like cancer, typically exclude medically complex patients. In the absence of evidence, the American Geriatrics Society's recommendations for the care of adults with multimorbidity provide a useful starting point for clinicians. We present a case to demonstrate how the AGS recommendations can be tailored to the situation of symptom management in patients with multimorbidity. We also present suggestions for future research directions.Discussion:Multimorbidity is an incredibly common and overlooked problem in our healthcare system, and only stands to increase in relevance as patients live longer and have the opportunity to accrue a greater burden of chronic illness. A comprehensive approach to patients with multimorbidity includes focusing on patient preferences, carefully interpreting the available evidence (including both the benefits and potential harms), and thinking critically about the burden of any treatment. Taking time to elicit patient goals and preferences, and apprise patients of their prognosis if they want to know, are especially important in symptom management discussions with patients with multimorbidity.