Ukunyamekela kwabantwana abane-Lung Cancer: Yintoni ofuna ukuyifumana?
Nokuba uthetha igama elithi hospice liloyiko kunomntu ophila nomhlaza. Ngelishwa, igama elithi hospice ngenye ixesha lilingana nokuyeka, nangona likude.
Ngomdlavuza wamaphaphu, abaninzi abantu abahluleki ukufumana izibonelelo zokubhedlele kuze kube yimihla yokugqibela yokugula kwabo. Ngethuba elifanayo, abanye abantu bakhetha i-hospice abangazi ukuba kukho iindlela ezintsha kunye ezifanelekileyo zokuphatha umdlavuza othile ophezulu wamaphaphu .
Yintoni oyifunayo ukuba uyazi ukuba unikwe igunya ngokuthatha isigqibo malunga nokugula; bobabini beqinisekisa ukuba "anqumle umpu" ukuba uhlala unyango olunokuthi unokwandisa ubomi kunye nemiphumo emibini, kwaye ukhethe le ndlela yokunyamekela ngokukhawuleza ukuba unokufumana izibonelelo?
Kutheni Kubalulekile Ukuthetha Nge-Hospice Xa Uvakalelwa?
Phakathi kwabantu abanomdlavuza wamaphaphu , siyazi ukuba i-hospice isetyenziswa. Siyazi nokuba abaninzi abantu bakhetha i-hospice kuphela ekupheleni kobomi babo-iintsuku zokugqibela kwaye mhlawumbi iiveki-zilahlekile ezininzi zeenzuzo zale nkqubo.
Ngelo xesha, unyango lomhlaza wemiphunga ushintshile ngokuphawulekayo kwiminyaka yakutshanje, kwaye kubekho ukutshintsha kwipharadi ekulawuleni izigaba eziphambili zesifo. Imilinga engazange ivezwe kwiminyaka elishumi eyadlulayo ngoku ivumela abanye abantu ukuba baphile ixesha elide kunexesha elidlulileyo; nangomdla wesifo somhlaza wesigaba 4.
Phakathi kwesi shintsho, unokwazi njani ukuba ixesha lokukhetha i-hospice? Masiqale ngokuthetha malunga nantoni na i-hospice kunye nento enokuthetha ngayo kuwe. Emva koko masithethe ngeendlela zokwenza esi sigqibo esibuhlungu.
Ngelishwa, izifundo zixelela ukuba oogqirha abaninzi abahluleki ukunyamekela ukunakekelwa kwezibhedlele. Oko kuthetha ukuthini wena kunye nosapho lwakho kufuneka uqalise ingxoxo kunye nogqirha wakho, kwaye mhlawumbi ngaphambi kokuba kuvele imfuneko.
Ukongezelela ekubeni nethuba lokufumana inzuzo kwiinkonzo zokubhedlele, u-2017 uphando lubonise ukuba ingxoxo yokuqala ye-hospice kunye nabantu abanomdlavuza wamaphaphu kubangele unyango olungaphantsi kobomi ekupheleni kobomi. (Kwakungekho umahluko kumlinganiselo wokusinda phakathi kwalabo babecala unyango ekupheleni kobomi kunye nabo bangenalo.) Kwesinye isifundo, amalungu omndeni wabantu abanomdlavuza wamaphaphu abanobhaliso bokuqala bokubhalisa babenombono ongcono wokuphela Ubunonophelo bomntu obathandayo kunabo abangekho.
Yintoni Isibhedlele Ngomhlaza Weengculaza?
Endaweni ye "indawo," nangona kukho izibonelelo ezinikezela ngononophelo lwama-hospice, i-hospice ininzi yefilosofi. Kuchazwa nje ngokuba ngumsebenzi onika abantu ngononophelo kunye novelwano kubantu abakwimigangatho yokugqibela yezifo ezingenakuphulukiswa ukuze baphile ngokuzeleyo nangentuthuko njengoko kunokwenzeka.
Injongo yokugulisa i-hospice iyayiphatha umntu kunokuba isifo ngendlela engazange iqhume okanye ibuyisele ukufa.
Abantu abaninzi banokudideka phakathi kokunakekelwa kwe-hospice kunye nokunyamekela ngokunyamekela kokubili ukugxininisa ekuphumuleni kweempawu kwaye kunika inkxaso, ngokomoya nangokomoya. Ukwahlula okuphambili kukuba ukunyamekela ngentsholongwane kungasetyenziselwa nayiphi na ixesha, nangomdlavuza ophilisayo, kodwa ukunakekelwa kwe-hospice yenzelwe abantu kwiinyanga ezi-6 zokugqibela zobomi.
Kukho iinkolelo ezininzi malunga nokunakekelwa kwezibhedlele , kubandakanya inkolelo yokuba xa ukhetha ukunakekelwa kwababelethi "uyayeka." Oku kukude nenyaniso, kwaye ekukhetheni abantu abagulayo bahlala becinga isigqibo sokuba baphile iintsuku zabo zokugqibela ngesidima nangothuthuzelo.
Akunabo bonke ukunakekelwa kwe-hospice okufanayo, kwaye kukho ngokwenene amazinga amane ahlukeneyo okunyamekela ukunyamekela esibhedlele esekelwe kwingcaciso ye-Medicare. Ezi ziquka:
- Inqanaba 1: Unonophelo lwempilo rhoqo. Ukunyamekela kunika iinkonzo ezisisiseko ekunyamekelweni kwabongikazi ukuxhasa inkxaso.
- Inqanaba 2: ukunakekelwa kwekhaya okuqhubekayo. Ukunyamekelwa kwekhaya okuqhubekayo ngokuqhelekileyo kukhokhetho olufutshane olusetyenziswayo xa ubuhlungu obukhulu okanye ukuphefumula okufutshane. Inkathalo iphinda ihlolwe rhoqo ngosuku kwaye umongikazi okanye uncedo lwezempilo lwasekhaya luvela kwiiyure eziyi-8 ukuya kwii-24 ngosuku.
- Umgangatho wesi-3: Unonophelo lwengqondo lwabaguli. Le nkonzo ifana nokunyamekelwa kwenyango oluqhubekayo kodwa kunokuba abantu abakhetha ukhathalelo kwisibonelelo esibhedlele.
- Umgangatho wesi-4: Ukunyamekela ukuhlala. Ukunyamekela ukunyamekela kuyinkqubo yonyango yesikhashana yonyango kulabo bafumana ukunakekelwa kwe-hospice ye-level 1, kodwa ukunyamezela ukukhathazeka kubangela ubunzima kunye nosapho badinga ikhefu elifutshane. Ngokuqhelekileyo umda weentsuku ezingama-5 kule nkathalo.
Ziziphi iiNkonzo ezinikezwa yi-Hospice?
Kulula kakhulu ukuqonda iinkonzo ezinikezwa yi-hospice ukuba uyayiqonda ukuba i-hospice yenzelwe ukunakekela umntu ngokwenyama, ngokomoya nangokomoya, kungekhona nje umntu ofa, kodwa yonke intsapho. Ezinye zeenkonzo ezibonelelwa yi-hospice ziquka:
- Ulawulo lwempawu: Iqela lakho lononophelo lokubeletha lisebenza ukubonelela unyango kunye nenkxaso ekuncediseni iimpawu ezinjengeentlungu, ukuphefumula okufutshane , ukuncwina okanye ukuhlanza, kunye nezinye iimpawu zomhlaza wakho okanye iziphumo zonyango oye wazifumana.
- Unonophelo lwangaphantsi : Abantu abaninzi banokukhetha ukhathalelo lwasekhaya okanye olunyango lokugula. Kulabo banyula ukunakekelwa kwekhaya, ukunyamekela ukunyamekela (isithuba seentsuku ezi-5) kunikwa xa amalungu omndeni ephazamiseka okanye afuna ukuphuka ngenxa yezizathu.
- Unonophelo lokomoya: Iqela lakho lononophelo lokubeletha libandakanya abefundisi abanokukunceda ngemibuzo enzima ejongene nayo ekupheleni kobomi. Le nkathalo yenzelwe iimfuno zakho ezithile kwaye ayikhuthazi okanye ingabandakanyi enye inkqubo yonqulo kwenye.
- Ukufikelela kwe-24/7: Uyakwazi ukuqhagamshelana neqela lakho lononophelo lokubhedlele ngaluphi na ixesha lobusuku okanye ubusuku kunye nayiphi na imibuzo okanye izinto ozikhathazayo.
- Inkxaso yentsapho: Iqela le-hospice lusekelwe kwikhaya, kwaye ngaphezu kokuncedisa intsapho yakho ukuba iyayiqonda into ojongene nayo nempilo, inkxaso inikwa ngemibuzo yabo kunye neengxaki zemvakalelo. Iintlanganiso zentsapho zinokubanjelwa ukuze amalungu entsapho abe nokwabelana ngezinto abazivelayo, kwaye bathethe ngeengxaki zabo kunye nexhala.
- Unonophelo lokusondeza : Ngethuba lonyaka opheleleyo emva kokufa, i-hospice inika iinkonzo kumalungu entsapho ahlalayo. Oku kungaquka ukucebisa okanye abefundisi kumntu okanye ngefowuni.
Ngaba Usenokufumana Unyango Ngenkxaso Ejongene Nonyango?
Abantu abaninzi bayethusa ngokukhetha i-hospice njengoko bakholelwa ukuba unyango luyeka ngokupheleleyo. Oku akunjalo. Xa ukhetha ukwelashwa usenza isigqibo malunga nokusukela unyango lomhlaza wakho wamaphaphu, kodwa oku akuthethi ukuba zonke izibonelelo ziya kuyeka. Umehluko kukuba unyango lujolise ekuphumuleni kweempawu kunye nokuphucula umgangatho wobomi kunokuba unyangwe ngumhlaza ngokwawo.
Abanikezeli abanesifo esibhedlele abahlukeneyo banezikhokelo ezahlukeneyo malunga nento eyenza unyango olusebenzayo. Ngokomzekelo, ukusebenzisa ityhubhu yokutya kunokungabonwa ngenyameko yokunyamekela ngokuxhomekeke kwiziko elithile lokubhedlele. Ngomdlavuza wamaphaphu ngokukodwa, iinkqubo zokunakekelwa kwezibhedlele ziyakwazi ukuhluka kwizinto ezamkelekileyo ezifana nokulawulwa komonakalo owonakalisayo (kunye nokwakhiwa kwamanzi emiphakeni eneengqamzana zesifo somhlaza).
Ezinye iinkqubo zinokuqwalasela ukucoca amanzi okanye ukufaka amanyathelo okunciphisa ukuphucula umoya. Omnye umzekelo uya kuba intlungu okanye iintlobo ngenxa ye-boneastases. Maxesha ngamanye amaxesha asetyenziswa ukunciphisa intlungu, kodwa inokuthi ingathatyathwa njengolu hlobo lwe "unyango oluchanekileyo" kuxhomekeke kwirejista ethile yokubhedlele. Enye ingqalelo ingase ibe ukusetyenziswa kwamanzi amanzi xa umntu engumqondiso ngenxa yokudambisa amanzi.
Enyanisweni, unyango olujoliswe ngokutsha ngentlungu, ubunzima bokuphefumla, kunye neentlanzi, njengokuba injongo kukunyusa izinga lobomi.
Xa Ufanele Unyuse I-Hospice Ngomhlaza Weengculaza?
Izibhedlele zivame ukucetyiswa xa ubungozi kunye nemiphumo emibi yonyango olongezelelweyo luya kuba ngaphezu kweenzuzo. Ngokuqinisekileyo oku kukulinganisela ukuba umntu ngamnye kufuneka azilinganise, kwaye iimpendulo ziyahlukahluka phakathi kwabantu abahlukeneyo. Ayikho into ephosakeleyo neyangalunganga kule ndawo; kuphela isigqibo esilungele wena nentsapho yakho.
Kubalulekile ukuba uqaphele ukuba ngokuphambili kwonyango lomhlaza kwimiphunga kwiminyaka yamuva, kwanokuba utshintsho olwenzeka phakathi kuka-2015 no-2017, impendulo inokuba yinto ehluke kakhulu kunokuba yayiyiminyaka embalwa emfutshane edlulileyo.
Izinketho zonyango ezitsha zokuqwalasela ngaphambi kokukhetha i-Hospice
Kwixesha elidlulileyo, nomhlaza ongaphawulekiyo wamaphaphu kwakukho iindlela ezimbalwa kuphela. Uphulo lwe-radiation kwisimo somdlavuza ophakamileyo wamaphaphu ngokuyinhloko lujoliswe ekunciphiseni intlungu kunye nosizi. Yiyiphi eyona nto ihlala ishiya i-chemotherapy yedwa njengendlela yokukhetha ubomi obunokubangela ubomi; kwaye ukulinganisa ingozi kunye neenzuzo zeerimotherapy zemimiselo yimibuzo ephambili.
Oku kuye kwatshintshile kakhulu kwiinketho zonyango olutsha ezinjengezonyango ezijoliswe kuyo kunye ne-immunotherapy. Kubalulekile ukuba wonke umntu onomdlavuza wamangqamuzana ongeyena omncinci ane -profiling molecule (ukuhlolwa kofuzo) okwenziwe kwi-tumor yabo, kungekhona wonke umntu ofanelekileyo kwezi zonyango uyazi ukuba zikhoyo. Ukuba utshintsho olujoliswe kuko lufana nokuguqulwa kwe-EGFR , ukulungiswa kwe-ALK , okanye ukulungiswa kwakhona kwe-ROS1 .
I-Immunotherapy yinto enokuthi isebenze ngezinye iinkqubo (kunye kunye nabantu abaninzi) kunye nomhlaza wamaphaphu ophezulu. Ezi zonyango ziyakwazi ukuphumelela xa uvavanyo lwe-PD-L1 olubonisa amanqanaba aphakamileyo. Nangona i-immunotherapy izidakamizwa azisebenzi kuwo wonke umntu, zinokuthi, kubantu abathile, kubangele impendulo ehlala njalo (ukulawula okude komhlaza).
Izigulane ezijoliswe kuyo kunye ne-immunotherapy iziyobisi azikho ngaphandle kweempembelelo, kodwa zisoloko zinyamezeleka ngakumbi kunokhemotherapy yendalo.
Kubalulekile ukuba uqaphele ukuba, nangona ukuba unyango kunye neenjongo ezijoliswe, i-immunotherapy, okanye i-chemotherapy inokwandisa ubomi, abanye abantu baya kukhetha ukungaqhubela phambili unyango. Ukuhamba ngonyango lomhlaza kwanaluphi na uhlobo alulula kumntu, kwaye abanye abantu baziva bekhathele kakhulu ukuba baphishekele naluphi na unyango ekwenzeni ukhetho lwakho olufunekayo ukuzithobela zakho iiminqweno kwaye wenze ukhetho olulungele wena ngokwakho, njengoko uqaphela ngokupheleleyo izinto ozikhethayo. Ukongeza, nangona ezi zonyango zingasebenza ngamaxesha amaxesha, ekugqibeleni uninzi lwezokwelapha luyeka ukusebenza, kwaye isigqibo malunga nokufelwa kwe-hospice siya kujongana.
Ekubeni ukhetha ukubeleka kunokwenza ukhethe ukuyeka unyango olusenyakatho, uthathe isikhashana ukuthetha nentsapho yakho malunga nale micimbi yokuqwalasela ngaphambi kokuyeka unyango lomhlaza .
Imibuzo Yokubuza Ngaphambi Kokukhetha I-Hospice
Isigqibo sokukhetha i-hospice sinokumangalisa, kodwa kunokukunceda ukubuza imibuzo emininzi:
- Ngaba kukho naziphi iindlela zokwelapha ezisele? Xa ubuza lo mbuzo ungafuna ukubuza ngokukhethekileyo malunga nokukhethwa kwamakhemikhali, ukhetho olujoliswe kunyango, ukhetho lwe-immunotherapy, kwaye unokwenzeka naziphi na izilingo zonyango eziya kulungele wena.
- Iyintoni impawu yobomi bakho namhlanje? Yintoni onokuyinqwenela umgangatho wobomi? Ingaba naziphi na ezinye iindlela zokwelapha zinciphisa umgangatho wobomi?
- Ngaba unomsebenzi wokunakekelwa ngononophelo? Ukunyamekela kokunyamekela kuyinkathalo ejongene nenhlalakahle yakho yokwenyama, yemvakalelo kunye nokomoya nangona injongo yakho yonyango.
- Intsapho yakho ivakalelwa njani ngesigqibo sakho?
- Ngaba ukhathalelo lokubhedlele olufunyenwe yi-inshurensi yakho yonyango okanye i- Hospice Medicare inzuzo ?
Thatha umzuzwana ukuba uluhlu zombini inzuzo kunye nokungahleleki kokunakekelwa kwe-hospice . Ngamanye amaxesha ukubona oku kumaphepha omnyama nomhlophe kunokukwenza ukhetho lwakho lubonakale lucacileyo.
Indlela Yokufumana Uncedo Olujongene Nezibhedlele
Ukufumaneka kolondolozo lwabhedlele kuyahluka kuye kuxhomekeke kwindawo ohlala kuyo, kwaye kulula ukuba uhlala kwindawo edolophini kunendawo yasemaphandleni. Isigqibo sokuqala sinokugqiba isigqibo sokuba unqwenela ukuba ne-hospice ekhaya okanye ukuba unqwenela ukuba kwisiko lokubhedlele. Akukho nto ikhethekileyo, kwaye isigqibo esona sihle kukuthi wena nentsapho yakho uzive lilungele wena.
Uluntu oluninzi lunomniki-nkonzo olungaphezu kweyodwa, ngoko kuya kufuneka ukhethe ukuba ngubani oza kufeza imfuno yakho. I-oncologist yakho kunye nomhlengikazi oncology unokunceda. Ukuba ubandakanyeka kwiqela lenkxaso yomdlavuza wendawo yengingqi okanye uluntu, unokucela iziphakamiso ezivela kubantu ngokunjalo. Kukho nemibutho karhulumente kunye nemibutho kazwelonke, njengentlangano ye-hospice yakho, oya kudibanisa nemibuzo.
Kutheni Ukuba Utshintsha Ingqondo Yakho?
Kubalulekile kunoma ubani okhetha ukunakekelwa kwe-hospice ukuze azi ukuba kulungile ukutshintsha ingqondo yakho. Ukuba unqwenela ukuqhubeka kwakhona unyango lomhlaza osebenzayo, okanye ukuba isicatshulwa esitsha ukunyanga umdlavuza wamaphaphu uvunyiwe kwaye ukhetho lwakho, unokuhlala ushiya i-hospice.
ILizwi
Ukuthetha ngokubhedlele kwintetho enzima kubantu abanomdlavuza kunye ne-oncologists ngokufanayo. Ngelishwa, siyazi ukuba bambalwa abantu abakhetha ukuhlala esibhedlele kuze kube sekusondele ukufa, kwaye balahlekelwa ezininzi kwiinkonzo ezinokubaluleka. Isigqibo malunga nokuhlala esibhedlele nomhlaza wamaphaphu sichaza ngakumbi imibuzo kunye neengqwalasela kunexesha elidlulileyo, ngenxa yenkqubela phambili kunyango lomhlaza wamaphaphu ophezulu njengemithi ejoliswe kuyo kunye ne-immunotherapy.
Akukho bantu ababini okanye i-khancer two efana, kwaye akukho bani unokukwenza esi sigqibo esibalulekileyo kuwe. Kubalulekile ukuqonda zonke iinketho zakho, uze wenze ukhetho oluhlonipha iimfuno zakho kunye neentsapho zakho. Oko kwathiwa, uphando oluninzi lufumene ukuba iintsapho zabantu abanomdlavuza wemiphunga bakholelwa ukuba umgangatho wabo wobomi wawuthandeke ngakumbi xa unyango lwabhedlele lukhethwa ngaphambili kungekudala emva kwezigaba zokugqibela zesifo.
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> Schuler, M., Joyce, N., Huskamp, H., Lamont, E., noL. Hatfield. Abaxhamli be-Medicare Nge-Advanced Lung Cancer Experience Iipatheni ezahlukeneyo zoNonophelo ezivela kwi-Diagnosis kuya ekufeni. Imiba yezeMpilo . 2017. 36 (7): 1193-1200.
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> Yoo, S., Keam, B., Kim, M. et al. I-Impact ye-Hospice Consultation kwi-Treatment Aggressive of Cancer. Uphando lweCans and Treatment . 2017 Julayi 14. (Epub phambi kokuprinta).