Cheville Andrea L, Morrow Melissa, Smith Sean Robinson, Basford Jeffrey R
Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905(∗).
Department of Health Sciences Research, Mayo Clinic, Rochester, MN(†).
PM R. 2017 Sep;9(9S2):S335-S346. doi: 10.1016/j.pmrj.2017.07.073.
The growing acceptance of palliative care has created opportunities to increase the use of rehabilitation services among populations with advanced disease, particularly those with cancer. Broader delivery has been impeded by the lack of a shared definition for palliative rehabilitation and a mismatch between patient needs and established rehabilitation service delivery models. We propose the definition that, in the advanced cancer population, palliative rehabilitation is function-directed care delivered in partnership with other clinical disciplines and aligned with the values of patients who have serious and often incurable illnesses in contexts marked by intense and dynamic symptoms, psychological stress, and medical morbidity to realize potentially time-limited goals. Although palliative rehabilitation is most often delivered by inpatient physical medicine and rehabilitation consultation/liaison services and by physical therapists in skilled nursing facilities, outcomes in these settings have received little scrutiny. In contrast, outpatient cancer rehabilitation programs have gained robust evidentiary support attesting to their benefits across diverse settings. Advancing palliative rehabilitation will require attention to historical barriers to the uptake of cancer rehabilitation services, which include the following: patient and referring physicians' expectation that effective cancer treatment will reverse disablement; breakdown of linear models of disablement due to presence of concurrent symptoms and psychological distress; tension between reflexive palliation and impairment-directed treatment; palliative clinicians' limited familiarity with manual interventions and rehabilitation services; and challenges in identifying receptive patients with the capacity to benefit from rehabilitation services. The effort to address these admittedly complex issues is warranted, as consideration of function in efforts to control symptoms and mood is vital to optimize patients' autonomy and quality of life. In addition, manual rehabilitation modalities are effective and drug sparing in the alleviation of adverse symptoms but are markedly underused. Realizing the potential synergism of integrating rehabilitation services in palliative care will require intensification of interdisciplinary dialogue.
姑息治疗越来越被接受，这为增加晚期疾病患者，尤其是癌症患者对康复服务的使用创造了机会。但由于缺乏姑息康复的统一界定，以及患者需求与既定康复服务模式不匹配，更广泛的服务提供受到了阻碍。我们提出如下定义：在晚期癌症患者群体中，姑息康复是一种功能导向型护理，它与其他临床学科合作开展，并与患有严重且往往无法治愈疾病的患者的价值观保持一致，这些患者处于症状强烈且多变、心理压力大以及存在医疗并发症的环境中，以实现可能有时限的目标。虽然姑息康复通常由住院物理医学与康复咨询/联络服务以及熟练护理机构中的物理治疗师提供，但这些环境中的治疗效果很少受到审查。相比之下，门诊癌症康复项目已获得有力的证据支持，证明了其在不同环境中的益处。推进姑息康复需要关注癌症康复服务推广过程中的历史障碍，其中包括：患者和转诊医生期望有效的癌症治疗能逆转残疾状况；由于并发症状和心理困扰导致残疾线性模型的崩溃；反射性姑息治疗与损伤导向治疗之间的紧张关系；姑息治疗临床医生对手工干预和康复服务的熟悉程度有限；以及识别有能力从康复服务中受益的接受度高的患者方面存在的挑战。解决这些公认复杂问题的努力是有必要的，因为在控制症状和情绪的努力中考虑功能对于优化患者的自主性和生活质量至关重要。此外，手工康复方式在缓解不良症状方面有效且节省药物，但使用明显不足。要实现将康复服务整合到姑息治疗中的潜在协同作用，需要加强跨学科对话。
