Currow David C, Wheeler Jane L, Glare Paul A, Kaasa Stein, Abernethy Amy P
Department of Palliative and Supportive Services, Flinders University, Adelaide, Australia.
J Pain Symptom Manage. 2009 Mar;37(3):373-86. doi: 10.1016/j.jpainsymman.2008.03.020. Epub 2008 Sep 21.
Palliative medicine has only recently joined the ranks of evidence-based medical subspecialties. Palliative medicine is a rapidly evolving field, which is quickly moving to redress its historical paucity of high-quality research evidence. This burgeoning evidence base can help support the application of evidence-based principles in palliative and hospice clinical care and service delivery. New knowledge is generally taken into practice relatively slowly by established practitioners. At present, the translation of evidence into palliative and hospice care clinical practice lags behind emerging research evidence in palliative care at even greater rates for three critical reasons: 1) the application of research results to specific clinical subpopulations is complicated by the heterogeneity of palliative care study subpopulations and by the lack of a recognized schema for describing populations or services; 2) definitional issues in service provision are, at best, confusing; and 3) fundamental research concepts (e.g., external validity, effect size, generalizability, applicability) are difficult to apply meaningfully in palliative care. This article provides a suggested framework for classifying palliative care research subpopulations and the clinical subpopulations to which the research findings are being applied to improve the ability of clinicians, health planners, and funders to interpret and apply palliative care research in real-world settings. The framework has five domains: patients and caregivers; health professionals; service issues; health and social policy; and research.
姑息医学直到最近才跻身循证医学亚专业的行列。姑息医学是一个快速发展的领域，正迅速弥补其历史上高质量研究证据匮乏的状况。这一迅速增长的证据基础有助于支持在姑息和临终关怀临床护理及服务提供中应用循证原则。新知识通常被执业已久的从业者相对缓慢地应用于实践。目前，将证据转化为姑息和临终关怀临床实践的速度比姑息治疗领域新出现的研究证据滞后得更严重，原因主要有三点：1）姑息治疗研究亚人群的异质性以及缺乏公认的描述人群或服务的模式，使得将研究结果应用于特定临床亚人群变得复杂；2）服务提供中的定义问题，往好里说也令人困惑；3）基本研究概念（如外部效度、效应量、可推广性、适用性）难以在姑息治疗中有意义地应用。本文提供了一个建议框架，用于对姑息治疗研究亚人群以及研究结果所应用的临床亚人群进行分类，以提高临床医生、卫生规划者和资助者在现实环境中解释和应用姑息治疗研究的能力。该框架有五个领域：患者和照护者；卫生专业人员；服务问题；卫生和社会政策；以及研究。
