Teoli Dac, Schoo Caroline, Kalish Virginia B.
University of California, Riverside
VOLUNTEERS OF AMERICA PACE
The World Health Organization characterizes the field of palliative care as a form of specialized medical care that aims to optimize the quality of life and alleviate the suffering of patients. One of the primary ways to achieve this is through early identification and treatment of new symptoms, along with managing those that prove refractory. Palliative care addresses the physical, psychosocial, and spiritual needs of patients with a serious illness, including but not limited to those with a life-limiting diagnosis, by employing an interprofessional team approach. A palliative team is comprised of a wide array of professionals, including the palliative physician, nurse, social worker, chaplain, and pharmacist. Notably, palliation consists of comprehensive care provided to patients with life-limiting illnesses and should not be considered an alternative to failed life-prolonging care. Early utilization of palliative care has been correlated with improved survival in patients with metastatic cancer, reduced cost of care, and improved quality of life. Palliative care can be administered in multiple settings and by various healthcare providers. Primary care providers, hospitalists, and emergency medicine physicians often provide the first interventions for palliative concerns. However, some specialists have completed a fellowship in hospice and palliative medicine. As an official subspecialty recognized by the American Board of Medical Specialties (ABMS), completion of a fellowship is needed to sit for the ABMS or American Osteopathic Association board certification examinations. A specialist in palliative care is often sought out for complex cases, refractory or difficult-to-manage symptoms, complex family dynamics, and patients who may need additional guidance and care. Specialists in palliative care may also have more time to dedicate solely to palliative care during their visits. Some hospitals employ a team of palliative care providers. Patients can be referred to palliative care in both outpatient and hospital settings. Currently, the following specialties are pathways to completing an HPM fellowship: internal medicine, family medicine, emergency medicine, psychiatry, neurology, surgery, pediatrics, radiology, obstetrician/gynecologist, anesthesiology, and physical medicine and rehabilitation. Therefore, palliative care physicians have formal training in at least one of these specialties. Palliative care is often delivered by an interdisciplinary team, with each member working within their specific specialty and area of focus. For example, palliative care teams often include chaplains and social workers who help address patients' spiritual and emotional needs. It is common for palliative care teams to employ physicians, physician assistants, nurse practitioners, nurses, social workers, and chaplains.
世界卫生组织将姑息治疗领域描述为一种专业医疗护理形式，旨在优化患者生活质量并减轻其痛苦。实现这一目标的主要途径之一是通过早期识别和治疗新出现的症状，以及处理那些难治性症状。姑息治疗通过采用跨专业团队方法，满足患有严重疾病患者的身体、心理社会和精神需求，这些患者包括但不限于那些患有危及生命诊断的患者。姑息治疗团队由众多专业人员组成，包括姑息治疗医生、护士、社会工作者、牧师和药剂师。值得注意的是，姑息治疗是为患有危及生命疾病的患者提供的全面护理，不应被视为对无效的延长生命护理的替代方案。早期使用姑息治疗与转移性癌症患者生存率提高、护理成本降低以及生活质量改善相关。姑息治疗可以在多种环境中由不同的医疗服务提供者提供。初级保健提供者、住院医生和急诊医学医生通常会对姑息治疗问题进行首次干预。然而，一些专科医生完成了临终关怀与姑息医学的 fellowship（专科培训）。作为美国医学专业委员会（ABMS）认可的官方亚专业，需要完成 fellowship 才能参加 ABMS 或美国骨病协会的委员会认证考试。对于复杂病例、难治性或难以管理的症状、复杂的家庭动态以及可能需要额外指导和护理的患者，通常会寻求姑息治疗专家的帮助。姑息治疗专家在出诊时可能也有更多时间专门致力于姑息治疗。一些医院雇佣了一组姑息治疗提供者。患者在门诊和医院环境中都可以被转介接受姑息治疗。目前，以下专业是完成临终关怀与姑息医学 fellowship 的途径：内科、家庭医学、急诊医学、精神病学、神经病学、外科、儿科、放射学、妇产科、麻醉学以及物理医学与康复。因此，姑息治疗医生在这些专业中至少有一个接受过正规培训。姑息治疗通常由跨学科团队提供，每个成员在其特定专业和关注领域内工作。例如，姑息治疗团队通常包括帮助满足患者精神和情感需求的牧师和社会工作者。姑息治疗团队雇佣医生、医师助理、执业护士、护士、社会工作者和牧师是很常见的。
