Gray Bradford H
Milbank Quarterly, and Urban Institute, Washington, D.C., USA.
Issue Brief (Commonw Fund). 2011 Jul;15:1-15.
In the U.S. health care system, and in those of many other countries, the care of dying patients is generally not performed well, with pain and other distress frequently undertreated and patients' preferences not respected. England's evidence-based End of Life Care Strategy could prove instructive. This issue brief discusses the origins, content, and implementation of the Strategy, as well as its potential impact. Both England and the United States struggle with similar challenges, including looking beyond the province of hospice and palliative-care specialists and initiating palliative services before the patient's final days. Aspects of the English approach that may be useful in the United States include strategies to help physicians recognize when patients are entering a trajectory that may end in death, the use of "death at home" as a metric for measuring progress, improving the skills of clinical and caregiving personnel through Web-based training, and developing a national improvement pathway.
在美国医疗保健系统以及许多其他国家的医疗保健系统中，对临终患者的护理通常做得并不好，疼痛和其他不适常常得不到充分治疗，患者的偏好也得不到尊重。英国基于证据的临终关怀战略可能具有借鉴意义。本问题简报讨论了该战略的起源、内容和实施情况，以及其潜在影响。英国和美国都面临着类似的挑战，包括超越临终关怀和姑息治疗专家的范畴，在患者生命的最后日子之前启动姑息治疗服务。英国方法中可能对美国有用的方面包括帮助医生识别患者何时进入可能以死亡告终的病程的策略、将“在家中死亡”作为衡量进展的指标、通过网络培训提高临床和护理人员的技能，以及制定全国性的改进路径。
