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姑息治疗的全球状况——癌症护理中的进展与挑战

The global state of palliative care-progress and challenges in cancer care.

作者信息

Reville Barbara, Foxwell Anessa M

机构信息

Palliative Care Program, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1202 Penn Tower, Philadelphia, PA 19104, USA.

Palliative Care Program, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.

出版信息

Ann Palliat Med. 2014 Jul;3(3):129-38. doi: 10.3978/j.issn.2224-5820.2014.07.03.

Abstract

All persons have a right to palliative care during cancer treatment and at the end-of-life. The World Health Organization (WHO) defines palliative care as a medical specialty that addresses physical, psychological, social, legal, and spiritual domains of care by an interdisciplinary team of professional and lay health care providers. Widespread adoption of this universal definition will aid policy development and educational initiatives on a national level. The need for palliative care is expanding due to the aging of the world's population and the increase in the rate of cancer in both developed and developing countries. However, in one third of the world there is no access to palliative care for persons with serious or terminal illness. Palliative care improves symptoms, most frequently pain, and improves quality of life for patients and their families, especially in the terminal disease phase. Accessibility to palliative care services, adequately trained health care professionals, availability of essential medicines, and gaps in education vary greatly throughout the world. Pain management is an integral concept in the practice of palliative care; however, opioiphobia, insufficient supply of opioids, and regulatory restrictions contribute to undue suffering for millions. Ongoing advocacy efforts call for increased awareness, palliative care integration with cancer care, and public and professional education. Enacting necessary change will require the engagement of health ministries and the recognition of the unique needs and resources of each country. The aim of this review is to examine progress in palliative care development and explore some of the barriers influencing cancer care across the globe.

摘要

所有人在癌症治疗期间及生命终末期都有权接受姑息治疗。世界卫生组织(WHO)将姑息治疗定义为一门医学专业,由专业和非专业医疗服务提供者组成的跨学科团队负责处理护理的身体、心理、社会、法律和精神层面。广泛采用这一通用定义将有助于国家层面的政策制定和教育倡议。由于世界人口老龄化以及发达国家和发展中国家癌症发病率的上升,对姑息治疗的需求正在扩大。然而,在世界三分之一的地区,患有严重疾病或绝症的人无法获得姑息治疗。姑息治疗可改善症状,最常见的是疼痛,并提高患者及其家人的生活质量,尤其是在疾病终末期。姑息治疗服务的可及性、训练有素的医疗专业人员、基本药物的供应以及教育差距在世界各地差异很大。疼痛管理是姑息治疗实践中的一个重要概念;然而,对阿片类药物的恐惧、阿片类药物供应不足以及监管限制导致数百万人遭受不必要的痛苦。正在进行的宣传工作呼吁提高认识、将姑息治疗与癌症治疗相结合以及开展公众和专业教育。实施必要的变革将需要卫生部的参与以及对每个国家独特需求和资源的认识。本综述的目的是研究姑息治疗发展的进展,并探讨影响全球癌症治疗的一些障碍。

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