Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
J Pain Symptom Manage. 2013 Aug;46(2):254-64. doi: 10.1016/j.jpainsymman.2012.07.018. Epub 2012 Nov 15.
Palliative care in the U.S. has evolved from a system primarily reliant on community-based hospices to a combined model that includes inpatient services at most large hospitals. However, these two dominant approaches leave most patients needing palliative care-those at home (including nursing homes) but not yet ready for hospice-unable to access the positive impacts of the palliative care approach. We propose a community-based palliative care (CPC) model that spans the array of inpatient and outpatient settings in which palliative care is provided and links seamlessly to inpatient care; likewise, it would span the full trajectory of advanced illness rather than focusing on the period just before death. Examples of CPC programs are developing organically across the U.S. As our understanding of CPC expands, standardization is needed to ensure replicability, consistency, and the ability to relate intervention models to outcomes. A growing body of literature examining outpatient palliative care supports the role of CPC in improving outcomes, including reduction in symptom burden, improved quality of life, increased survival, better satisfaction with care, and reduced health care resource utilization. Furthermore the examination of how to operationalize CPC is needed before widespread implementation can be realized. This article describes the key characteristics of CPC, highlighting its role in longitudinal care across patient transitions. Distinguishing features include consistent care across the disease trajectory independent of diagnosis and prognosis; inclusion of inpatient, outpatient, long-term care, and at-home care delivery; collaboration with other medical disciplines, nursing, and allied health; and full integration into the health care system (rather than parallel delivery).
美国的姑息治疗已经从一个主要依赖社区 Hospice 的系统发展为一个结合了大多数大型医院提供住院服务的模式。然而，这两种主要方法使大多数需要姑息治疗的患者（包括在家中（包括疗养院）但尚未准备好接受 Hospice 的患者）无法获得姑息治疗方法的积极影响。我们提出了一种基于社区的姑息治疗（CPC）模式，该模式涵盖了提供姑息治疗的各种住院和门诊环境，并与住院治疗无缝连接；同样，它将涵盖整个晚期疾病的轨迹，而不仅仅是关注临终前的阶段。CPC 项目的例子正在美国各地自然发展。随着我们对 CPC 的理解的扩展，需要进行标准化以确保可复制性、一致性以及将干预模型与结果联系起来的能力。越来越多的研究门诊姑息治疗的文献支持 CPC 在改善结局方面的作用，包括减轻症状负担、提高生活质量、延长生存时间、提高对护理的满意度和减少医疗保健资源的利用。此外，在广泛实施之前，需要研究如何实施 CPC。本文描述了 CPC 的关键特征，强调了其在患者过渡期间进行纵向护理的作用。其突出特点包括在不依赖于诊断和预后的情况下，在疾病轨迹上保持一致的护理；包括住院、门诊、长期护理和家庭护理服务的提供；与其他医学学科、护理和相关健康专业的合作；以及完全融入医疗保健系统（而不是并行提供）。
