全科医学中姑息治疗患者的早期识别：制定拉德堡姑息治疗需求指标（RADPAC）。
Early identification of palliative care patients in general practice: development of RADboud indicators for PAlliative Care Needs (RADPAC).
机构信息
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
出版信息
Br J Gen Pract. 2012 Sep;62(602):e625-31. doi: 10.3399/bjgp12X654597.
BACKGROUND
According to the World Health Organization (WHO) definition, palliative care should be initiated in an early phase and not be restricted to terminal care. In the literature, no validated tools predicting the optimal timing for initiating palliative care have been determined.
AIM
The aim of this study was to systematically develop a tool for GPs with which they can identify patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer respectively, who could benefit from proactive palliative care.
DESIGN
A three-step procedure, including a literature review, focus group interviews with input from the multidisciplinary field of palliative healthcare professionals, and a modified Rand Delphi process with GPs.
METHOD
The three-step procedure was used to develop sets of indicators for the early identification of CHF, COPD, and cancer patients who could benefit from palliative care.
RESULTS
Three comprehensive sets of indicators were developed to support GPs in identifying patients with CHF, COPD, and cancer in need of palliative care. For CHF, seven indicators were found: for example, frequent hospital admissions. For COPD, six indicators were found: such as, Karnofsky score ≤50%. For cancer, eight indicators were found: for example, worse prognosis of the primary tumour.
CONCLUSION
The RADboud indicators for PAlliative Care Needs (RADPAC) is the first tool developed from a combination of scientific evidence and practice experience that can help GPs in the identification of patients with CHF, COPD, or cancer, in need of palliative care. Applying the RADPAC facilitates the start of proactive palliative care and aims to improve the quality of palliative care in general practice.
背景
根据世界卫生组织（WHO）的定义，姑息治疗应在早期阶段开始，而不仅仅限于临终关怀。在文献中，尚未确定预测启动姑息治疗最佳时机的经过验证的工具。
目的
本研究旨在为全科医生开发一种工具，以便他们能够识别患有充血性心力衰竭（CHF）、慢性阻塞性肺疾病（COPD）和癌症的患者，这些患者可以从积极的姑息治疗中受益。
设计
包括文献复习、多学科姑息治疗专业人员参与的焦点小组访谈以及与全科医生进行的改良 Rand Delphi 流程在内的三步程序。
方法
三步程序用于开发用于早期识别可从姑息治疗中受益的 CHF、COPD 和癌症患者的指标集。
结果
开发了三组综合指标，以支持全科医生识别需要姑息治疗的 CHF、COPD 和癌症患者。对于 CHF，发现了七个指标：例如，频繁住院。对于 COPD，发现了六个指标：例如，Karnofsky 评分≤50%。对于癌症，发现了八个指标：例如，原发性肿瘤预后更差。
结论
RADPAC（姑息治疗需求的拉德博德指标）是第一个结合科学证据和实践经验开发的工具，可帮助全科医生识别需要姑息治疗的 CHF、COPD 或癌症患者。应用 RADPAC 有助于开始积极的姑息治疗，并旨在提高一般实践中的姑息治疗质量。
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