Department of Medicine,University of Melbourne,Melbourne,Victoria,Australia.
Northern Adelaide Palliative Service and Discipline of Medicine,University of Adelaide,Adelaide,South Australia,Australia.
Palliat Support Care. 2018 Aug;16(4):452-460. doi: 10.1017/S147895151700044X. Epub 2017 May 31.
ABSTRACTBackground:Despite significant needs, patients with chronic obstructive pulmonary disease (COPD) make limited use of palliative care, in part because the current models of palliative care do not address their key concerns.
Our aim was to develop a tailored model of palliative care for patients with COPD and their family caregivers.
Based on information gathered within a program of studies (qualitative research exploring experiences, a cohort study examining service use), an expert advisory committee evaluated and integrated data, developed responses, formulated principles to inform care, and made recommendations for practice. The informing studies were conducted in two Australian states: Victoria and South Australia.
A series of principles underpinning the model were developed, including that it must be: (1) focused on patient and caregiver; (2) equitable, enabling access to components of palliative care for a group with significant needs; (3) accessible; and (4) less resource-intensive than expansion of usual palliative care service delivery. The recommended conceptual model was to have the following features: (a) entry to palliative care occurs routinely triggered by clinical transitions in care; (b) care is embedded in routine ambulatory respiratory care, ensuring that it is regarded as "usual" care by patients and clinicians alike; (c) the tasks include screening for physical and psychological symptoms, social and community support, provision of information, and discussions around goals and preferences for care; and (d) transition to usual palliative care services is facilitated as the patient nears death.
Our proposed innovative and conceptual model for provision of palliative care requires future formal testing using rigorous mixed-methods approaches to determine if theoretical propositions translate into effectiveness, feasibility, and benefits (including economic benefits). There is reason to consider adaptation of the model for the palliative care of patients with other nonmalignant conditions.
为慢性阻塞性肺疾病（COPD）患者及其家庭照护者开发一种定制的姑息治疗模式。
基于在一系列研究项目中收集的信息（定性研究探索经验，队列研究检查服务使用情况），一个专家顾问委员会评估并整合了数据，制定了应对措施，制定了指导护理的原则，并提出了实践建议。这些研究是在澳大利亚的两个州进行的：维多利亚州和南澳大利亚州。
确定了一系列支撑该模型的原则，包括：（1）以患者和照护者为中心；（2）公平，使有重大需求的群体能够获得姑息治疗的各个组成部分；（3）易于获得；（4）比扩大常规姑息治疗服务的资源密集度更低。建议的概念模型具有以下特点：（a）姑息治疗的介入是常规的，由护理中的临床过渡触发；（b）护理嵌入常规的门诊呼吸护理中，确保患者和临床医生都将其视为“常规”护理；（c）任务包括筛查身体和心理症状、社会和社区支持、提供信息以及围绕治疗目标和偏好进行讨论；（d）随着患者接近死亡，促进向常规姑息治疗服务的过渡。
我们提出的姑息治疗提供的创新和概念模型需要未来使用严格的混合方法进行正式测试，以确定理论假设是否转化为有效性、可行性和益处（包括经济效益）。有理由考虑为其他非恶性疾病患者的姑息治疗改编该模型。
