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

患有严重疾病的人在生命即将结束时经历了一段旅程，在这段旅程中，他们经历了几个临界点。尽管我们知道这些临界点对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可能发生的确切时间，以及不同类型的人它们可能会如何变化。我们需要知道什么时候是开始取消侵入性和纯治疗性治疗的最佳时机，何时是讨论濒临死亡的最佳时机，以及在我们目前的医疗体系中，我们如何才能照顾来自不同背景和信仰的人。我们还需要确定和推广最好的可能方式来支持生命末期的患者及其家人，因为他们正在协商通往美好死亡的往往复杂的道路。有了这样的信息，卫生保健从业者，特别是那些参与姑息治疗的人，可以设计出更好的服务，使所有人都易于理解和获得对患者和家庭需求的评估、转介到最适当的服务以及协调护理的所有方面。这种护理可能很昂贵，所以我们需要明智地使用分配给姑息治疗的钱。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内减轻痛苦的最佳方法。公平和公平的卫生保健制度不仅关乎保持人们的健康，而且关乎人道地处理死亡的必然性

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