Determining critical points in the potential palliative care pathway in the last year of life

患有严重疾病的人在接近生命的尽头时会经历一段旅程，在这段旅程中，他们会经历几个关键点。虽然我们知道这些临界点对于他们如何获得最好的护理至关重要，但我们不确定这些临界点何时会出现，以及它们对不同类型的人有何不同。我们需要知道什么时候是开始退出侵入性和纯治疗性治疗的最佳时机，什么时候是讨论接近死亡的最佳时机，以及我们如何在现有的卫生保健系统中照顾来自不同背景和信仰的人。我们还需要确定和促进在生命结束时支持患者及其家属的最佳方式，因为他们正在谈判通往良好死亡的复杂道路。有了这类信息，卫生保健从业人员，特别是参与缓和医疗的从业人员，可以设计更好的服务，建立途径，使所有人都易于理解和获得对病人和家属需求的评估、转诊到最适当的服务和协调护理的所有方面。这种治疗可能很昂贵，所以我们需要明智地使用分配给姑息治疗的资金。这可以通过深思熟虑的研究来实现，在最需要的时候确定最需要的人，并调查在死亡前几周和几个月减轻痛苦的最佳方法。一个公平和公平的卫生保健系统不仅仅是为了保持人们的健康，也是为了人道地处理不可避免的死亡

People with serious illnesses who are approaching the end of their lives undergo a journey where, along the way, they experience several critical points. Although we know these critical points are crucial to how they might access the best kind of care, we are unsure exactly when these points may occur and how they may vary for different kinds of people. We need to know when is the best time to start withdrawing invasive and purely curative treatments, when are discussions about approaching death best introduced and how we can care for people from a diverse range of backgrounds and beliefs within our current health care system. We also need to identify and promote the best possible ways of supporting patients at the end of life and their families as they negotiate the often complex path towards a good death. With this kind of information, health care practitioners, particularly those involved in palliative care, can design better services that put in place pathways where assessment of patient and family needs, referral to the most appropriate services and coordination of all the aspects of care are easy to understand and access for all people. This kind of care can be expensive so we need to use the money allocated to palliative care wisely. This can be achieved with thoughtful research that identifies those most in need, at the time of most need and investigates the best approaches to alleviating pain in suffering in the weeks and months before death. A fair and equitable health care system is not just about keeping people healthy, but also about dealing humanely with the inevitability of death