Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
J Pain Symptom Manage. 2012 Aug;44(2):192-205. doi: 10.1016/j.jpainsymman.2011.09.009. Epub 2012 Jun 15.
Throughout Europe, there are major differences in the stages of development and in the types of service delivery of palliative care. Consensus on standards and norms for palliative care in Europe is needed for advocacy and health policy decision making.
To provide an empirical basis for a common understanding of palliative care delivery in Europe.
A two-round, online consensus Delphi study was undertaken with a multiprofessional expert panel of board members of national hospice and palliative care associations in Europe.
Respondents represented 80% of the member associations of the European Association for Palliative Care, comprising 96 experts and 35 national hospice and palliative care associations from 22 countries. High to very high consensus was found for common values and principles of palliative care (e.g., autonomy, dignity) and the provision of different levels of palliative care. Lower consensus emerged for concepts such as end-of-life care or terminal care, the demand of services and the composition of palliative care teams. The role of social workers was emphasized, but there was ambiguity about the contribution of psychologists. The need for health professionals without specialist palliative care skills to strengthen their contribution to palliative care provision was emphasized.
Overall, this study contributed to a higher level of consensus toward the proposed recommendations. Expert comments underlined the need for clearer definitions and specifications of terms and indicated important topics where cultural issues, geographical aspects, and the local health care setting have to be considered in palliative care.
在整个欧洲，姑息治疗的发展阶段和服务提供类型存在很大差异。需要就姑息治疗的标准和规范达成共识，以便进行宣传和做出卫生政策决策。
为欧洲姑息治疗提供的共识提供实证依据。
采用两轮在线共识 Delphi 研究，对象为欧洲姑息治疗协会国家临终关怀和姑息治疗协会的多专业专家委员会成员。
受访者代表欧洲姑息治疗协会的 80%成员协会，包括来自 22 个国家的 96 名专家和 35 个国家临终关怀和姑息治疗协会。姑息治疗的共同价值观和原则（例如自主权、尊严）以及不同层次的姑息治疗的提供方面达成了高度至非常高度的共识。在临终关怀或终末期护理、服务需求和姑息治疗团队组成等概念方面，共识较低。社会工作者的作用得到强调，但心理学家的贡献存在模糊性。强调需要没有专科姑息治疗技能的卫生专业人员加强对姑息治疗服务的贡献。
总体而言，这项研究有助于就拟议建议达成更高水平的共识。专家评论强调需要更清楚地定义和规范术语，并指出姑息治疗中需要考虑文化问题、地理方面和当地医疗保健环境的重要议题。
