Hui David, Bruera Eduardo
Department of Palliative Care & Rehabilitation Medicine Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, Houston, USA.
Ann Palliat Med. 2015 Jul;4(3):89-98. doi: 10.3978/j.issn.2224-5820.2015.04.01.
Palliative care aims to improve cancer patients' quality of life through expert symptom management, psychosocial and spiritual care, patient-clinician communication, facilitation of complex decision making, and end-of-life care planning. Over the past few years, there has been increasing interest and evidence to support integration of oncology and palliative care. However, it remains unclear how best to promote integration. The goal of this review is to examine contemporary conceptual models and clinical approaches to integrate oncology and palliative care.
Narrative review.
Conceptual models are useful to help stakeholders understand the rationale for integration, to compare the risks and benefits among different practices, and to define a vision towards integration. We will review four major conceptual models of integration, including (I) the time-based model which emphasizes on integration based on chronological criterion; (II) the provider-based (palli-centric) model which discusses primary, secondary and tertiary palliative care; (III) the issue-based (onco-centric) model which illustrates the advantages and disadvantages of the solo practice, congress and integrated care approaches; and (IV) the system-based (patient-centric) model which emphasizes automatic referral based on clinical events. Clinical models provide actual data on the feasibility, efficacy and effectiveness of integration in specific settings. The evidence and challenges related to selected clinical models in integrating oncology and palliative care, such as outpatient palliative care clinics and embedded clinics will be discussed.
There are multiple conceptual models and clinical models to promote integration. Further research is needed to inform best practices for integration at different healthcare settings.
姑息治疗旨在通过专业的症状管理、心理社会和精神关怀、医患沟通、协助复杂决策以及临终关怀规划，提高癌症患者的生活质量。在过去几年中，人们对肿瘤学与姑息治疗整合的兴趣日益浓厚，且有证据支持这一整合。然而，目前尚不清楚如何以最佳方式促进整合。本综述的目的是研究整合肿瘤学与姑息治疗的当代概念模型和临床方法。
叙述性综述。
概念模型有助于利益相关者理解整合的基本原理，比较不同实践中的风险和益处，并确定整合的愿景。我们将回顾四种主要的整合概念模型，包括：（I）基于时间的模型，该模型强调基于时间顺序标准的整合；（II）基于提供者（以姑息治疗为中心）的模型，该模型讨论了一级、二级和三级姑息治疗；（III）基于问题（以肿瘤学为中心）的模型，该模型阐述了单独实践、联合实践和综合护理方法的优缺点；以及（IV）基于系统（以患者为中心）的模型，该模型强调基于临床事件的自动转诊。临床模型提供了在特定环境中整合的可行性、有效性和效果的实际数据。将讨论与整合肿瘤学和姑息治疗的选定临床模型（如门诊姑息治疗诊所和嵌入式诊所）相关的证据和挑战。
有多种概念模型和临床模型可促进整合。需要进一步研究以指导不同医疗环境下整合的最佳实践。
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