Zimmermann Camilla, Ryan Suzanne, Hannon Breffni, Saltman Alexandra, Rodin Gary, Mak Ernie, Al-Awamer Ahmed, Lau Jenny
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Support Palliat Care. 2019 Aug 12. doi: 10.1136/bmjspcare-2019-001903.
Although the effectiveness of early palliative care for patients with advanced cancer has been demonstrated in several trials, there has been no detailed published description of an early palliative care intervention.
In this paper, we delineate the iterative conception and systematic evaluation of a complex intervention called team-based outpatient early palliative care (TO-EPC), and describe the components of the intervention. The intervention was developed based on palliative care theory, review of previous palliative care interventions and practice guidelines. We conducted feasibility testing and piloting of TO-EPC in a phase 2 trial, followed by evaluation in a large cluster randomised trial and qualitative research with patients and caregivers. The qualitative research informed the iterative refinement of the intervention.
Four principles and four domains of care constitute a conceptual framework for TO-EPC. The main domains of care are: coping and support, symptom control, decision-making and future planning. The main principles are that care is flexible, attentive, patient-led and family-centred. The most prominent domain for the initial consultation is coping and support; follow-up visits focus on symptom control, decision-making to maximise quality of life and future planning according to patient readiness. Key tasks are described in relation to each domain.
The description of our intervention may assist palliative care teams seeking to implement it, researchers wishing to replicate or build on it and oncologists hoping to adapt it for their patients.
尽管多项试验已证明早期姑息治疗对晚期癌症患者的有效性，但尚未有关于早期姑息治疗干预措施的详细公开描述。
在本文中，我们阐述了一种名为基于团队的门诊早期姑息治疗（TO-EPC）的复杂干预措施的迭代构思和系统评估，并描述了该干预措施的组成部分。该干预措施是基于姑息治疗理论、对既往姑息治疗干预措施的回顾以及实践指南而制定的。我们在一项2期试验中对TO-EPC进行了可行性测试和试点，随后在一项大型整群随机试验中进行评估，并对患者和护理人员进行了定性研究。定性研究为干预措施的迭代完善提供了依据。
四项原则和四个照护领域构成了TO-EPC的概念框架。主要照护领域包括：应对与支持、症状控制、决策制定和未来规划。主要原则是照护具有灵活性、专注性、以患者为主导且以家庭为中心。初次咨询中最突出的领域是应对与支持；随访就诊则侧重于症状控制、根据患者意愿做出决策以最大化生活质量以及未来规划。针对每个领域描述了关键任务。
我们对干预措施的描述可能会帮助寻求实施该措施的姑息治疗团队、希望复制或在此基础上进行拓展的研究人员以及希望为其患者进行调整的肿瘤学家。
