Katić M, Lazić Kašuba, Soldo D
Acta Med Croatica. 2015 Nov;69(4):233-44.
Palliative care is defined as the care for patients whose disease is not responsive to curative treatment. The goals of palliative care are symptom control, life prolongation and enabling the best possible quality of life for patients and their families. For most patients with an advanced progressive incurable disease, 90% of care in their last year of life is provided at home by family physician and his team and patient family. Patients suffering from cancer have a mean of of 11.9 symptoms in the last three months of life. The most common symptoms are digestive tract symptoms and pain. The growth and spread of cancer, as well as the therapeutic procedures applied are the most important causes of symptoms. The most common symptoms in patients with cancer of digestive system are nausea, vomiting, constipation, pain, cachexia, anorexia, and psychological problems. These most common symptoms and many others will be of varying intensity and appearance depending on localization and aggressiveness of digestive system cancer, modality of treatment and patient condition. Patients with advanced cancer have longer survival and all health care professionals involved in the care of patients should have more knowledge and skills necessary to effectively treat various symptoms. Coordination, organization and implementation of palliative care in family medicine, when large part of care is provided at patient home, are one of the most complex tasks of family physician. This task requires a family practitioner with specific knowledge and skills to know how effectively control a number of symptoms and to provide adequate support to the patient and his family. Communication between doctor and patient suffering from advanced cancer of digestive system is a fundamental aspect of care. The quality of communication significantly affects the course of treatment, the benefit to patients and their families, the choice of treatment and adherence to treatment, as well as care planning. In the management of patients with advanced cancer of the digestive system, family physician should use holistic approach and respect the patient as a person and his decision.
姑息治疗被定义为对疾病无法通过根治性治疗治愈的患者的护理。姑息治疗的目标是控制症状、延长生命，并使患者及其家人尽可能享有最佳生活质量。对于大多数患有晚期进行性不治之症的患者来说，他们生命中最后一年90%的护理是由家庭医生及其团队以及患者家属在家中提供的。癌症患者在生命的最后三个月平均有11.9种症状。最常见的症状是消化道症状和疼痛。癌症的生长和扩散以及所应用的治疗程序是症状的最重要原因。消化系统癌症患者最常见的症状是恶心、呕吐、便秘、疼痛、恶病质、厌食和心理问题。这些最常见的症状以及许多其他症状会因消化系统癌症的部位和侵袭性、治疗方式以及患者状况而在强度和表现上有所不同。晚期癌症患者生存期更长，所有参与患者护理的医护人员都应具备更多有效治疗各种症状所需的知识和技能。在家庭医疗中，当大部分护理在患者家中提供时，姑息治疗的协调、组织和实施是家庭医生最复杂的任务之一。这项任务要求家庭医生具备特定的知识和技能，以了解如何有效控制多种症状，并为患者及其家人提供充分支持。与晚期消化系统癌症患者的医患沟通是护理的一个基本方面。沟通质量会显著影响治疗进程、对患者及其家人的益处、治疗选择和治疗依从性以及护理计划。在晚期消化系统癌症患者的管理中，家庭医生应采用整体方法，尊重患者本人及其决定。
