Krouse Robert S
Southern Arizona Veterans Affairs Health Care System, University of Arizona College of Medicine, Tucson, Arizona 85723, USA.
J Pain Symptom Manage. 2007 Jul;34(1 Suppl):S1-6. doi: 10.1016/j.jpainsymman.2007.04.005. Epub 2007 Jun 4.
There is a dearth of well-designed clinical research focusing on palliative care in cancer patients, especially those who are near the end of life. Reasons for this include ethical dilemmas in conducting such trials, communication barriers between specialties, and unclear standards for best care practices. To ensure that patients with incurable illnesses are offered the best available care, it is essential to develop and disseminate research methodologies well suited to this population. Given the multidimensional and culture-dependent nature of the end-of-life experience, it is necessary to adopt an interdisciplinary approach to developing research methods. As a means of initiating the process of palliative clinical research methodology development, malignant bowel obstruction (MBO) was used as a model to develop a research protocol. Although many treatment options for MBO have been proposed, existing literature offers little guidance with regard to algorithms for optimal management. To this end, an international leaders in quality-of-life research, ethnocultural variability, palliative medicine, surgical oncology, gastroenterology, major consortium research, medical ethics, and patient advocacy/cancer survivors was convened in Pasadena, California, on November 12-13, 2004. Participants also represented the broad ethnic and racial perspectives required to develop culturally sensitive research methods. Consensus on methodological approaches was attained through vigorous debate. Using the conference-developed MBO model to implement trials will advance palliative care research.
针对癌症患者,尤其是那些接近生命末期的患者的姑息治疗,缺乏精心设计的临床研究。造成这种情况的原因包括开展此类试验时的伦理困境、各专业之间的沟通障碍以及最佳护理实践的标准不明确。为确保为患有不治之症的患者提供最佳可用护理,开发并推广非常适合这一人群的研究方法至关重要。鉴于临终体验具有多维度和文化依赖性,采用跨学科方法来开发研究方法很有必要。作为启动姑息临床研究方法开发过程的一种手段,将恶性肠梗阻(MBO)用作开发研究方案的模型。尽管已经提出了许多针对MBO的治疗选择,但现有文献在最佳管理算法方面几乎没有提供指导。为此,2004年11月12日至13日在加利福尼亚州帕萨迪纳召集了生活质量研究、种族文化差异、姑息医学、外科肿瘤学、胃肠病学、大型财团研究、医学伦理学以及患者权益倡导/癌症幸存者方面的国际领军人物。与会者还代表了开发具有文化敏感性的研究方法所需的广泛种族和民族观点。通过激烈辩论达成了关于方法学方法的共识。使用会议开发的MBO模型来开展试验将推动姑息治疗研究。