Ukwelashwa Kwebhedlela Kwabantu Abanomdlavuza We-Lung: Yini Okudingeka Uyazi?
Ngisho nokukhuluma igama lokubhedlela liyesabisa kunoma ubani ophila nomdlavuza. Ngeshwa, igama lesi-hospice ngezinye izikhathi lilingana nokuyeka, nakuba likude nalokho.
Ngomdlavuza wamaphaphu, abantu abaningi abahluleki ukuthola izinzuzo zokubhedlela kuze kube sekupheleni kwezinsuku zokugula kwabo. Ngesikhathi esifanayo, abanye abantu bakhetha ukugula okungazi ukuthi kungenzeka kube nezindlela ezintsha nezisebenzayo zokwelapha umdlavuza wabo wamaphaphu othuthukile .
Yini okudingeka ukwazi ukuthi unikwe amandla ekwenzeni isinqumo mayelana nesibhedlela; bobabili beqinisekisa ukuthi "awunqamuli isibhamu" uma kutholakala ukwelashwa okuphumelelayo okungase kwandise ukuphila ngemiphumela emibi embalwa, futhi ukhethe le ndlela yokunakekela maduze ukuze ukwazi ukuthola izinzuzo?
Kungani Kubalulekile Ukukhuluma Nge-Hospice Uma Uzizwa Uhle?
Phakathi kwabantu abanomdlavuza wamaphaphu , siyazi ukuthi isibhedlela siyasetshenziswa. Siphinde sazi ukuthi abantu abaningi bakhetha i-hospice kuphela ekupheleni kokuphila kwabo-izinsuku zokugcina futhi mhlawumbe amasonto-abalahlekelwa izinzuzo zaloluhlelo.
Ngesikhathi esifanayo, ukwelashwa komdlavuza wamaphaphu kuye kwashintsha ngokuphawulekayo eminyakeni yamuva, futhi kube khona ushintsho lweparadigm ekuphathweni kwezigaba eziphambili zesifo. Imithi engakazwakala eminyakeni eyishumi eyedlule manje ivumela abanye abantu ukuba baphile isikhathi eside kunanesikhathi esidlule; ngisho nesigaba somdlavuza wesine 4.
Phakathi nalolu shintsho, ungazi kanjani ukuthi sekuyisikhathi sokukhetha ukwelashwa? Ake siqale ngokukhuluma ngokuqondile nalokho okushiwo i-hospice nokuthi kungasho ukuthini kuwe. Khona-ke ake sikhulume ngokuthi singenza kanjani lesi sinqumo esibuhlungu.
Ngeshwa, ucwaningo lusitshela ukuthi odokotela abaningi abahluleka ukuletha ukunakekelwa kwezingane ezibhedlela. Lokhu kusho ukuthi wena nomndeni wakho kungadingeka ukuthi niqale ingxoxo nodokotela wakho, futhi mhlawumbe ngaphambi kokuba kudingeke isidingo.
Ngaphandle kokuthola ithuba lokuzuza ezinsizeni zokubhedlela, isifundo se-2017 sathola ukuthi ukuxoxwa kokuqala kwe-hospice nabantu abanomdlavuza wamaphaphu kwabangele ukwelashwa okungenangqondo ekupheleni kokuphila. (Kwakungekho umehluko ekungeneni kokuphila phakathi kwalabo abanobudlova obunzima ekupheleni kokuphila nalabo abangazange bakwenze.) Kwesinye isifundo, amalungu omndeni wabantu abanomdlavuza wamaphaphu ababesebenzela ukubhaliswa kokuqala kokubhedlela babenombono ongcono wokuphela ukuphila kunakekelwa othandekayo wabo kunabo abangakwenzi.
Kuyini Isibhedlela Sengculaza Yengculazi?
Esikhundleni se "indawo," nakuba kunezikhungo ezinikezela ukunakekelwa esibhedlela, izifo eziningi ziyifilosofi. Ichazwa njengomkhuba ohlinzeka ngokunakekelwa komuntu nokuhawukela abantu ezigabeni zokugcina zezifo ezingelapheki ukuze baphile ngendlela egcwele futhi ekhululekile ngangokunokwenzeka.
Umgomo we-hospice uyiphatha umuntu kunokuba isifo ngendlela engasheshe isheshe noma ihlehlise ukufa.
Abantu abaningi badidekile phakathi kokunakekelwa kwe-hospice nokunakekelwa ngokucophelela njengoba kokubili kugxile ekusizeni izimpawu futhi kunikeze ukusekelwa ngokomzimba, ngokomzwelo nangokomoya. Umehluko oyinhloko wukuthi ukunakekelwa ngokucophelela kungasetshenziswa noma kunini, ngisho nomdlavuza ophulukisayo, kodwa ukunakekelwa kwe-hospice kwenzelwe abantu ezinyangeni ezingu-6 zokugcina zokuphila.
Kunezinkolelo eziningi mayelana nokunakekelwa kwe-hospice , kufaka phakathi inganekwane yokuthi ekukhetheni ukunakekelwa kwezingane zokubeletha "uyayeka". Lokhu akude neqiniso, futhi ekukhetheni abantu abahlala esibhedlela bavame ukwenza isinqumo sokuthi baphile izinsuku zabo zokugcina ngesithunzi nangenduduzo.
Akuwona wonke ukunakekelwa kwe-hospice okufanayo, kanti empeleni kunamazinga amane ahlukene wokunakekelwa kokunakekelwa esibhedlela esekelwe incazelo ye-Medicare. Lokhu kufaka:
- Izinga 1: Ukunakekelwa kwempilo njalo. Lokhu kunakekelwa kunikeza izinsizakalo eziyisisekelo ekunakekelwa kwezingane ukunakekelwa ngokomzwelo.
- Izinga 2: ukunakekelwa kwekhaya okuqhubekayo. Ukunakekela ekhaya okuqhubekayo kuvame ukukhetha isikhathi esifushane esetshenziswa lapho ubuhlungu obukhulu noma ukuphefumula okukhona. Ukunakekelwa kuhlolwa kabusha ngosuku ngalunye futhi usizo lomhlengikazi noma lwezempilo ekhaya luvela emahoreni angu-8 kuya kwangu-24 ngosuku.
- Izinga 3: Ukunakekelwa okujwayelekile kwezingane. Le nsizakalo ifana nokunakekelwa kwekhaya okuqhubekayo kodwa kunabantu abakhetha ukunakekelwa esibhedlela.
- Izinga le-4: Ukukhathalela abahlali. Ukukhathalela ukuhlala ngaphandle kuyindlela yokwelashwa yesikhashana yilabo abathola ukunakekelwa kwe-level 1 yesibhedlela, kodwa ukunakekelwa kwengcindezi kubangela ubunzima nomndeni kudinga ikhefu elifushane. Ngokuvamile kunomkhawulo wezinsuku ezingu-5 kulokhu kunakekelwa.
Yiziphi Izinkonzo Ezihlinzeka Nge-Hospice?
Kulula ukuqonda izinsizakalo ezinikezwa i-hospice uma uqonda ukuthi isibhedlela senzelwe ukunakekela umuntu ngokwenyama, ngokomzwelo, nangokomoya, hhayi nje umuntu ofa, kodwa wonke umndeni. Ezinye zezinsizakalo ezihlinzekwa yi-hospice zihlanganisa:
- Ukulawula isifo: Ithimba lakho lokunakekelwa kwe-hospice lisebenza ukuhlinzeka ngemithi nokusekela ukusiza ngezinpawu ezifana nobuhlungu , ukuphefumula , ukucabangela noma ukuhlanza, nezinye izimpawu zomdlavuza wakho noma imiphumela emibi yezokwelapha ozitholile.
- Ukunakekelwa kwesineke : Abantu abaningi bangakhetha ukwelashwa kwezingane noma iziguli ezikhulelwe. Kulabo abakhetha ukunakekelwa kwekhaya, ukunakekelwa kwezingane zokuphumula (isikhathi esingaphezu kwezinsuku ezingu-5) kunikelwa uma amalungu omndeni ekhungathekile noma edinga ikhefu nganoma yisiphi isizathu.
- Ukunakekelwa okungokomoya: Ithimba lakho lokunakekelwa kwe-hospice lihlanganisa abefundisi abangakusiza ngemibuzo enzima ebhekene nokuphela kokuphila. Lokhu kunakekelwa kuklanyelwe izidingo zakho ezithile futhi akukhuthazi noma kungabandakanyi umkhuba owodwa wenkolo ngaphezu komunye.
- Ukufinyelela kwe-24/7: Uzokwazi ukuxhumana neqembu lakho lokunakekela i-hospice nganoma yisiphi isikhathi sosuku noma ubusuku nganoma yimiphi imibuzo noma ukukhathazeka onakho.
- Ukwesekwa komndeni: Ithimba labahlengikazi liwumndeni, futhi ngaphezu kokusiza umndeni wakho ukuthi uqonde ukuthi ubhekane nobani ngemithi, ukusekelwa kunikezwa imibuzo yabo kanye nezinkinga zomzwelo. Imihlangano yomndeni ingabanjelwa ukuze amalunga omndeni akwazi ukuhlanganyela lokho abazizwayo, futhi akhulume ngokumesaba nokukhathazeka kwabo.
- Ukunakekelwa kokunakekelwa : Ngesikhathi sokuphela konyaka ngemuva kokufa, ukubeletha kunikezela izinsizakalo kumalungu omndeni osinda. Lokhu kungafaka ukululekwa noma abefundisi ngomuntu noma ngocingo.
Ungabe Usayithola Ukwelashwa Ngenkathi Ngaphansi Kwezempilo?
Abantu abaningi bayesaba ngokukhetha ukwelashwa ngoba bakholelwa ukuthi ukwelashwa kuyeka ngokuphelele. Lokhu akulona iqiniso. Ekukhetheni ukwelashwa wenza isinqumo ngokumelene nokuphishekela ukwelashwa komdlavuza wakho wamaphaphu, kepha lokhu akusho ukuthi zonke izifo zizoyeka. Umehluko wukuthi ukwelashwa kugxila ekukhululeni kwezimpawu nokuthuthukisa ikhwalithi yakho yokuphila esikhundleni sokwelapha umdlavuza ngokwawo.
Abanikezeli ababhekene nezifo ezahlukene banemihlahlandlela ehlukene kulokho okwenza ukwelashwa okusebenzayo. Isibonelo, ukusebenzisa ithubhu yokudla kungenzeka noma kungabhekwa ukunakekelwa kwe-palliative kuye ngokuthi i-ejensi yokugula ekhethekile. Ngomdlavuza wamaphaphu ngokuqondile, izinhlelo zokunakekela izifo zingase zihluke kulokho okwamukelekayo njengokuphathwa kwe-effusion ebulalayo yomsindo (ukwakhiwa kwamanzi emaphashini anesifo somdlavuza).
Ezinye izinhlelo zingase zicabangele ukukhipha uketshezi noma ukufaka izinyathelo zokuqeda izinhlungu ezenza ngcono ukuphefumula. Esinye isibonelo kungaba ubuhlungu noma ukuhlukana ngenxa yamathambo ayisithupha. Ngezinye izikhathi ukusetshenziswa kwezidakamizwa (noma amathambo okuguqula amathambo) kusetshenziselwa ukunciphisa ubuhlungu, kodwa kungenzeka noma kungabhekwa njengendlela "yokwelapha okusebenzayo" kuye ngokuthi i-ejenti elithile lokubeletha. Okunye ukucatshangelwa kungase kube ukusetshenziswa kwamanzi okugcoba uma umuntu ephawulekayo ngenxa yokuphela kwamanzi.
Yiqiniso, ukwelashwa okubhekiswe kakhulu ekuhluphekeni, ubunzima bokuphefumula, kanye nezinselele, njengoba umgomo ukukhulisa izinga lakho lokuphila.
Kufanele Ukhethe Nini I-Hospice Nge-Cancer Lung?
I-hospice ivame ukuphakanyiswa uma izingozi nemiphumela emibi yokwelashwa okuqhubekayo kuzokwandisa izinzuzo. Ngokuqinisekile lokhu kubhalansi umuntu ngamunye okudingeka azenzele wona, futhi impendulo ingahluka kakhulu phakathi kwabantu abahlukene. Akukho okulungile nokungalungile kulesi sici; kuphela isinqumo esilungele wena nomndeni wakho.
Kubalulekile ukuphawula ukuthi ngokuthuthukiswa komdlavuza wamaphaphu eminyakeni yamuva, ngisho nezinguquko ezenzeka phakathi kuka-2015 no-2017, impendulo ingase ihluke kakhulu kunalokho okungeke ibe yiminyaka embalwa edlule.
Izinketho ezintsha zokwelashwa okufanele uzicabangele ngaphambi kokukhetha izibhedlela
Esikhathini esedlule, umdlavuza wamaphaphu ongenakusebenza wawukhona kuphela okukhethwa kukho okumbalwa. Ukwelashwa kwezidakamizwa ekusetshenzisweni komdlavuza wamaphaphu ethuthukile ngokuyinhloko kuyinkimbinkimbi-eyenzelwe ukunciphisa ubuhlungu nokuhlupheka. Yikuphi okwakuvame ukushiya i-chemotherapy yedwa njengendlela yokukhetha okungase kwandise impilo; futhi ukukala izingozi nezinzuzo zamakhemikhali e-chemotherapy kwakuwumbuzo oyinhloko.
Lokhu kushintshile kakhulu ngezinketho ezintsha zokwelashwa ezifana nezinqubo ezilindelekile zokwelapha kanye ne-immunotherapy. Kubalulekile ukuthi wonke umuntu onomdlavuza wamangqamuzana omncane ongewona omncane abe nokuprofetha kwamangqamuzana (ukuhlolwa kofuzo) okwenziwe ngesisu sakhe, hhayi wonke umuntu ofanelekile kulezi zindlela zokwelapha uyazi ukuthi ziyatholakala. Uma ukuguqulwa okuhloswe okufana nokuguqulwa kwe- EGFR , ukulungiswa kabusha kwe-ALK , noma ukulungiswa kabusha kwegciwane le-ROS1 .
I-Immunotherapy ingenye indlela ephumelelayo ngezinye izikhathi (futhi ngokuphawulekayo kwabanye abantu) abanomdlavuza wamaphaphu ophakeme. Lezi zokwelapha kungenzeka ukuthi ziphumelele uma uhlola i-PD-L1 eveza amazinga aphezulu. Nakuba izidakamizwa ze-immunotherapy azisebenzi kuwo wonke umuntu, zingakwazi, kubantu abathile, ukuphendula ngendlela ehlala njalo (ukulawula isikhathi eside somdlavuza).
Imithi ehlosiwe kanye nezidakamizwa ze-immunotherapy ayinayo imiphumela emibi, kodwa ngokuvamile ivame ukubekezelela kangcono kakhulu kunokwelashwa kwamakhemikhali.
Kubalulekile ukuqaphela ukuthi, noma ngabe ukwelashwa ngamagciwane okuhlosiwe, i-immunotherapy, noma i-chemotherapy kungase kwandise ukuphila, abanye abantu bazokhetha ukungaphishekeli ukwelashwa okuqhubekayo. Ukubhekana nokwelashwa komdlavuza kwanoma yiluphi uhlobo akulula kunoma ubani, futhi abanye abantu bezwa bekhathele kakhulu ukuba baphishekele noma yiziphi ezinye zokwelashwa Ngokwenza ukhetho lwakho udinga ukuhlonipha izifiso zakho futhi wenze ukukhetha okungcono kakhulu kuwe, ngokude njengoba wazi ngokugcwele izinketho onayo. Ngaphezu kwalokho, nakuba lezi zindlela zokwelapha zingasebenza ngempumelelo ngezikhathi ezithile, ekugcineni izinqubo eziningi zokwelapha ziyeke ukusebenza, futhi isinqumo mayelana nokugula sizobhekana nazo.
Njengoba ukhetha ukwelashwa kukwenza ukhethe ukuyeka ukwelapha okuphuthumayo, thatha isikhashana ukukhuluma nomndeni wakho ngalezi zindaba okufanele uzicabangele ngaphambi kokuyeka ukwelashwa komdlavuza .
Imibuzo Yokubuza Ngaphambi Kokukhetha Izibhedlela
Isinqumo sokukhetha i-hospice singasinda, kodwa singasiza ukubuza imibuzo eminingana:
- Zikhona yini izinketho zokwelapha ezisele? Ekubuzeni lo mbuzo ungase ufune ukubuza ngokukhethekile mayelana nezinketho zamakhemikhali, izinketho zokwelashwa ezihlosiwe, izinketho ze-immunotherapy, nokuthi kungenzeka yini noma yikuphi ukuvivinywa kokwelashwa okungakufanelekile.
- Iyini izinga lakho lokuphila njenganamuhla? Ungathanda yini ukuthi izinga lakho lokuphila libe yilokho? Ingabe ezinye izindlela zokwelapha zinganciphisa izinga lakho lokuphila ngokuqhubekayo?
- Uke waba nokubonisana nokunakekelwa kokunakekelwa? Ukunakekelwa kwe-palliative kuyinakekelo ekhuluma kahle nenhlalakahle yakho engokwenyama, ngokomzwelo nangokomoya ngisho noma inhloso yakho iyindlela yokwelapha.
- Umndeni wakho uzizwa kanjani ngesinqumo sakho?
- Ingabe ukunakekelwa esibhedlela kubhekwe umshuwalense wakho wezokwelapha noma i- hospice Medicare inzuzo ?
Thatha isikhashana ukuthi ubhale phansi kokubili izinzuzo nezinkinga zokunakekelwa esibhedlela . Ngezinye izikhathi ukubona lokhu ephepheni ngamnyama nomhlophe kungenza ukukhetha kwakho kubonakale kucacile.
Indlela Yokuthola Ukunakekelwa Okunakekelwa Kakhulu Kwe-Hospice
Ukutholakala kokunakekelwa kwe-hospice kuyahlukahluka kuye ngokuthi uhlalaphi, futhi kuvame ukulula uma uhlala endaweni edolobheni kunendawo yasemaphandleni. Isinqumo sokuqala ukuthi unqume ukuthi ngabe ufisa yini ukuba nesibhedlela sasekhaya noma uma ufisa ukuba sesikhungweni sokugula. Akukho ukukhetha okulungile, futhi isinqumo esihle kunazo zonke wena nomndeni wakho uzizwa kulungile kuwe.
Imiphakathi eminingi inezihlinzekwa ezingaphezu kweyodwa, ngakho kuzodingeka ukhethe ukuthi yikuphi okuhle okuhlangabezana nesidingo sakho. I-oncologist yakho kanye nomhlengikazi oncology angasiza. Uma uhilelekile eqenjini lenkxaso yesifo somdlavuza wendawo yangasese noma umphakathi, ungacela izincomo ezivela kulaba bantu kanye. Kukhona nezinhlangano zombuso nezizwe, njengenhlangano yesibhedlela yakho, ongakwazi ukuxhumana nemibuzo.
Kuthiwani Uma Ushintsha Ingqondo Yakho?
Kubalulekile kunoma ubani okhetha ukunakekelwa esibhedlela ukuze azi ukuthi kuhle ukushintsha ingqondo yakho. Uma unquma ukuthi ufisa ukuphinde uphathe ukwelashwa komdlavuza osebenzayo, noma uma umuthi omusha ukwelapha umdlavuza wamaphaphu uvunyelwe futhi ukhetho ngawe, ungakwazi njalo ukuhamba esibhedlela.
Izwi elivela
Ukukhuluma nge-hospice ingxoxo enzima kubantu abanomdlavuza kanye ne-oncologists yabo ngokufanayo. Ngeshwa, siyazi ukuthi bambalwa kakhulu abantu abakhetha ukwelashwa kuze kube yilapho besondelene kakhulu nokufa, futhi baphuthele ezinsizeni eziningi ezinhle ezihlinzeka ngeziguli. Isinqumo mayelana ne-hospice nomdlavuza wamaphaphu sichaza imibuzo eminingi kanye nokucabangela kunokudlula esikhathini esidlule, ngenxa yentuthuko yomdlavuza wamaphaphu ethuthukile njengezokwelapha okubhekiswe kuzo kanye ne-immunotherapy.
Abekho abantu ababili noma ama-khansela amabili afanayo, futhi akekho ongakwenza lesi sinqumo esibalulekile kuwe. Kubalulekile ukuqonda zonke izinketho zakho, bese wenza ukukhetha okuhlonipha izidingo zakho kanye nabomndeni wakho. Lokhu kusho ukuthi izifundo eziningana zithole ukuthi imindeni yabantu abanomdlavuza wamaphaphu bakholelwa ukuthi izinga lomuntu omthandayo liphila kangcono uma ukunakekelwa esibhedlela sekukhethiwe ngaphambi kwalokho esikhathini esizayo kulezi zigaba.
> Imithombo:
> Ersek, M., Miller, S., Wagner, T. et al. Ukubambisana Phakathi Nokunakekelwa Okunzima Nokuhlolwa Kwemindeni Engenayo Ukuhlolwa Kwekuphela Kwokuphila Kwezilwane Zase-Veteran Nge-Can-Small Cell Lung Cancer Labo Abafa Emotweni Yezempi Izikhungo. I-Cancer . 2017. 123 (1): 3186-3194.
> Schuler, M., Joyce, N., Huskamp, H., Lamont, E., noL. Hatfield. Abahlomuli be-Medicare Nge-Advanced Lung Cancer Experience Ama-Patterns Ahlukahlukene Okunakekelwa Ukuthola I-diagnosis kuya Ekufeni. Izindaba zezeMpilo . 2017. 36 (7): 1193-1200.
> Wright, A., Keating, N., Avanian, J. et al. Imibono Yomndeni Ekunakekelweni Kwe-Cancer Okumangalisayo eduze Kokuphela Kwokuphila. I-JAMA . 2016. 315 (3): 284-92.
> Yoo, S., Keam, B., Kim, M. et al. Umthelela Wokubonisana Nezibhedlela Nge-Aggressive Treatment of Cancer Cancer. Ucwaningo lweCans and Treatment . 2017 July 14. (Epub ngaphambi kokuphrinta).