Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, 450 Brookline Avenue, Boston, MA 02115, USA.
J Natl Compr Canc Netw. 2012 Oct 1;10(10):1192-8. doi: 10.6004/jnccn.2012.0126.
While there are operational, financial, and workforce barriers to integrating oncology with palliative care, part of the problem lies in ourselves, not in our systems. First, there is oncologists' "learned helplessness" from years of practice without effective medications to manage symptoms or training in how to handle the tough communication challenges every oncologist faces. Unless they and the fellows they train have had the opportunity to work with a palliative care team, they are unlikely to be fully aware of what palliative care has to offer to their patients at the time of diagnosis, during active therapy, or after developing advanced disease, or may believe that, "I already do that." The second barrier to better integration is the compassion fatigue many oncologists develop from caring for so many years for patients who, despite the oncologists' best efforts, suffer and die. The cumulative grief oncologists experience may go unnamed and unacknowledged, contributing to this compassion fatigue and burnout, both of which inhibit the integration of oncology and palliative care. Solutions include training fellows and practicing oncologists in palliative care skills (eg, in symptom management, psychological disorders, communication), preventing and treating compassion fatigue, and enhancing collaboration with palliative care specialists in caring for patients with refractory distress at any stage of disease. As more oncologists develop these skills, process their grief, and recognize the breadth of additional expertise offered by their palliative care colleagues, palliative care will become integrated into comprehensive cancer care.
虽然将肿瘤学与姑息治疗相结合存在运营、财务和劳动力方面的障碍，但部分问题在于我们自身，而不是我们的系统。首先，由于多年来没有有效的药物来控制症状，也没有接受过如何应对每位肿瘤医生都面临的艰难沟通挑战的培训，肿瘤医生已经“习得性无助”。除非他们和他们培训的研究员有机会与姑息治疗团队合作，否则他们不太可能充分了解姑息治疗在诊断时、积极治疗期间或在发展为晚期疾病时能为患者提供什么，或者可能认为“我已经在做了”。更好地整合的第二个障碍是许多肿瘤医生在照顾多年的患者时产生的同情疲劳，尽管肿瘤医生尽了最大努力，患者还是遭受痛苦并死亡。肿瘤医生经历的累积悲伤可能没有被命名和承认，导致这种同情疲劳和倦怠，这两者都抑制了肿瘤学和姑息治疗的整合。解决方案包括培训研究员和执业肿瘤医生掌握姑息治疗技能（例如，在症状管理、心理障碍、沟通方面），预防和治疗同情疲劳，以及在姑息治疗专家的协作下，在疾病的任何阶段为有难治性痛苦的患者提供护理。随着越来越多的肿瘤医生发展这些技能，处理他们的悲伤，并认识到他们的姑息治疗同事提供的更广泛的专业知识，姑息治疗将被纳入综合癌症护理。
