Creating Effective Models for Delivering Palliative Care in Advanced Liver Disease.
Creating Effective Models for Delivering Palliative Care in Advanced Liver Disease.
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DOI：
10.1007/s11901-021-00562-0
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Bakitas MA
中科院分区：
文献类型：
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作者：
Verma M;Bakitas MA
目前的医疗保健系统没有完全配备为晚期肝病（ALD）患者及其护理人员提供全面支持，导致伴随的痛苦和生活质量（QoL）降低。在常规护理中整合姑息治疗（PC）已证明在改善症状和生活质量以及减少其他严重疾病的医疗保健利用方面具有益处，但在ALD护理中未得到充分利用或延迟。本文的目的是概述PC的领域和优势，并讨论PC集成的误解和障碍，以及支持ALD护理中PC集成的医疗保健交付模式。个人护理有八个关键领域，涉及身心健康、未来护理目标和护理人员的护理。PC提供了改善健康结果和患者满意度并降低医疗保健利用率的优势。到目前为止，已经出现了主要以医院或社区为基础的成功的预防犯罪模式;成功的模式是由预防犯罪专家或初级/综合医生领导的。肿瘤学中的并发PC已成为大多数循证指南的基础。ALD护理中的PC整合仍处于起步阶段。在积累ALD证据的同时，肝病学组织可以促进基于共识的综合PC模型，这些模型可以指导研究和实践工作，以增加对这些有需要的患者及其家庭护理人员的支持性护理。
The current healthcare system is not fully equipped to provide comprehensive support for patients with advanced liver disease (ALD) and their caregivers resulting in concomitant suffering and reduced quality of life (QoL). Integration of palliative care (PC) within routine care has demonstrated benefits in improving symptoms and QoL and reducing healthcare utilization for other serious illnesses but has been underutilized or delayed for ALD care. The purpose of this article is to outline the domains and benefits of PC and discuss the misconceptions and barriers for PC integration, and healthcare delivery models supporting PC integration within ALD care. PC has eight key domains related to physical and mental health, goals for future care, and care of the caregivers. PC offers benefits to improve health outcomes and patient satisfaction and reduce healthcare utilization. To date there have been successful models of PC that are primarily hospital- or community-based; successful models have been PC specialist- or primary/generalist-led. Concurrent PC within oncology has formed the basis for most evidence-based guidelines. PC integration within ALD care is still in its infancy. While amassing evidence in ALD, hepatology organizations can promote consensus-based integrated PC models that can guide research and practice efforts to increase supportive care for these patients in need and their family caregivers.