University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
Support Care Cancer. 2011 Mar;19(3):343-51. doi: 10.1007/s00520-010-0822-0. Epub 2010 Feb 16.
People with advanced cancer who may benefit from specialised palliative care (SPC) do not necessarily access such services.
To obtain a deeper understanding of issues affecting access to SPC, five focus groups were undertaken with nurses (35), physicians (three), allied health professionals (seven) and an academic involved in providing care.
Thematic analysis revealed that palliative care providers consistently view palliative care as a broad holistic approach to care benchmarked on good symptom management. Whilst participants themselves perceived SPC as aiming to maximise the quality of life of the patient and family across all domains of care, they perceived that some health professionals and community members viewed palliative care largely as symptom control and terminal care for access after all disease-modifying treatment has been exhausted. Concern was expressed that such misconceptions were an important barrier to timely SPC. Participants did not nominate a time or particular milestone in the disease process which should prompt referral and suggested that SPC be available at any time where needs are complex and/or are not being met.
Failure to properly recognise and understand the breadth of care provided within the palliative care framework may result in people with advanced cancer and their caregivers not accessing SPC services or accessing them too late to receive maximum benefit. Education may be required to promote the holistic nature of SPC services amongst health professionals and the community and to help realise the potential benefits to patients, families and health professionals resulting from timely access to SPC services.
可能受益于专科姑息治疗（SPC）的晚期癌症患者不一定能获得此类服务。
为了更深入地了解影响 SPC 可及性的问题，对五名护士（35 名）、三名医生、七名联合健康专业人员和一名参与提供护理的学术人员进行了五次焦点小组讨论。
主题分析显示，姑息治疗提供者始终将姑息治疗视为一种广泛的整体护理方法，以良好的症状管理为基准。虽然参与者自己认为 SPC 的目的是在所有护理领域最大化患者和家庭的生活质量，但他们认为一些卫生专业人员和社区成员将姑息治疗主要视为症状控制和在所有疾病修饰治疗耗尽后的临终关怀。有人担心，这种误解是及时获得 SPC 的重要障碍。参与者没有指定在疾病过程中的某个时间或特定里程碑，应该提示转介，并建议在需求复杂和/或未得到满足的任何时候都提供 SPC。
未能正确认识和理解姑息治疗框架内提供的护理的广度，可能导致晚期癌症患者及其护理人员无法获得 SPC 服务或获得服务太晚，无法获得最大收益。可能需要对卫生专业人员和社区进行姑息治疗服务的整体性质的教育，以帮助实现患者、家庭和卫生专业人员从及时获得姑息治疗服务中获得的潜在益处。
