Improving Patient and Caregiver Outcomes in Oncology: Team-Based, Timely, and Targeted Palliative Care
Improving Patient and Caregiver Outcomes in Oncology: Team-Based, Timely, and Targeted Palliative Care
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DOI：
10.3322/caac.21490
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发表时间：
2018-09-01
影响因子：
254.7
通讯作者：
Bruera, Eduardo
中科院分区：
文献类型：
--
作者：
Hui, David;Hannon, Breffni L.;Bruera, Eduardo
在过去的十年中，积累了大量的证据，支持将姑息治疗纳入晚期癌症患者的肿瘤学实践。问题不再是是否应该提供姑息治疗，而是什么是最佳的提供模式，什么时候是转诊的理想时间，谁最需要转诊，以及肿瘤学家自己应该提供多少姑息治疗。鉴于国际上姑息治疗资源的稀缺，这些问题尤其相关。在这篇针对癌症临床医生的最新科学综述中，作者首先讨论了当代研究专家姑息治疗对各种健康结果影响的文献。然后，提供概念模型，以支持团队为基础，及时，有针对性的姑息治疗。基于团队的姑息治疗允许跨学科成员全面解决患者及其护理人员的多维护理需求。及时的姑息治疗，在最好的情况下，是一种预防性护理，以尽量减少生命末期的危机。有针对性的姑息治疗包括确定最有可能从专科姑息治疗干预中受益的患者，类似于靶向癌症治疗的概念。最后，总结了门诊、嵌入式诊所、护士主导的姑息治疗、肿瘤团队提供的初级姑息治疗和自动转诊等创新医疗模式的优缺点。展望未来，需要进行更多的研究，以确定不同的卫生系统如何能够最好地个性化姑息治疗，以便在正确的环境中、在正确的时间为正确的患者提供正确的干预水平。(C) 2018年美国癌症协会。
Over the past decade, a large body of evidence has accumulated supporting the integration of palliative care into oncology practice for patients with advanced cancer. The question is no longer whether palliative care should be offered, but what is the optimal model of delivery, when is the ideal time to refer, who is in greatest need of a referral, and how much palliative care should oncologists themselves be providing. These questions are particularly relevant given the scarcity of palliative care resources internationally. In this state-of-the-science review directed at the practicing cancer clinician, the authors first discuss the contemporary literature examining the impact of specialist palliative care on various health outcomes. Then, conceptual models are provided to support team-based, timely, and targeted palliative care. Team-based palliative care allows the interdisciplinary members to address comprehensively the multidimensional care needs of patients and their caregivers. Timely palliative care, at its best, is preventive care to minimize crises at the end of life. Targeted palliative care involves identifying the patients most likely to benefit from specialist palliative care interventions, akin to the concept of targeted cancer therapies. Finally, the strengths and weaknesses of innovative care models, such as outpatient clinics, embedded clinics, nurse-led palliative care, primary palliative care provided by oncology teams, and automatic referral, are summarized. Moving forward, more research is needed to determine how different health systems can best personalize palliative care to provide the right level of intervention, for the right patient, in the right setting, at the right time. (C) 2018 American Cancer Society.