De Lima Liliana, Krakauer Eric L, Lorenz Karl, Praill David, Macdonald Neil, Doyle Derek
International Association for Hospice and Palliative Care, Houston, TX 77007, USA.
J Pain Symptom Manage. 2007 May;33(5):521-6. doi: 10.1016/j.jpainsymman.2007.02.006.
In response to a request from the World Health Organization (WHO), the International Association for Hospice and Palliative Care (IAHPC) developed a List of Essential Medicines for Palliative Care based on the consensus of palliative care workers from around the world. IAHPC designed a process of five steps, which included developing a set of ethical guidelines; identifying the most common symptoms in palliative care; identifying a list of medications to treat those symptoms; carrying out a survey using a modified Delphi process with participants from developed and developing countries; and convening a meeting of representatives from regional, international, and scientific organizations to develop the final list. Twenty-one symptoms were identified as the most common in palliative care, and an initial list of 120 medications resulted from the initial survey. Seventy-one participants from developing and developed countries responded to the Delphi survey and agreed on the effectiveness and safety of 48 medications for 18 of the 21 symptoms. The final step included discussions among representatives from 26 organizations, which led to the finalization of the list. The IAHPC List of Essential Medicines for Palliative Care includes 33 medications, of which 14 are already included in the WHO Model List. The participants agreed that there is too little evidence to recommend medications for five of the symptoms and suggested that further research be carried out to solve this need. The IAHPC and all the organizations involved in this process welcome suggestions on ways to continue to improve the List of Essential Medicines for Palliative Care and to improve access to medications for patients in need.
应世界卫生组织（WHO）的要求，国际临终关怀与姑息治疗协会（IAHPC）基于全球姑息治疗工作者的共识制定了一份姑息治疗基本药物清单。IAHPC设计了一个五步流程，包括制定一套伦理准则；确定姑息治疗中最常见的症状；确定治疗这些症状的药物清单；采用改进的德尔菲法对来自发达国家和发展中国家的参与者进行调查；以及召集区域、国际和科学组织的代表开会以制定最终清单。21种症状被确定为姑息治疗中最常见的症状，初步调查得出了一份120种药物的初始清单。来自发展中国家和发达国家的71名参与者对德尔菲调查做出了回应，并就48种药物对21种症状中的18种症状的有效性和安全性达成了一致。最后一步包括26个组织的代表进行讨论，最终确定了清单。IAHPC姑息治疗基本药物清单包括33种药物，其中14种已被列入WHO示范清单。参与者一致认为，对于其中5种症状，推荐用药的证据太少，并建议开展进一步研究以满足这一需求。IAHPC以及参与该过程的所有组织欢迎就如何继续改进姑息治疗基本药物清单以及改善有需要患者获得药物的途径提出建议。
