University of Technology Sydney, Ultimo, NSW, Australia.
University of Hull, Hull, United Kingdom.
J Clin Oncol. 2020 Mar 20;38(9):937-943. doi: 10.1200/JCO.18.02235. Epub 2020 Feb 5.
Patient-defined factors that are important at the end of life include being physically independent for as long as possible, good symptom control, and spending quality time with friends and family. Hospice care adds to the quality of care and these patient-centered priorities for people with cancer and their families in the last weeks and days of life. Evidence from large observational studies demonstrate that hospice care can improve outcomes directly and support better and more appropriate health care use for people in the last stages of cancer.Team-based community hospice care has measurable benefits for patients, their family caregivers, and health services. In addition to improved symptom control for patients and a greater likelihood of time spent at home, caregiver outcomes are better when hospice care is accessed: informational needs are better met, and caregivers have an improved ability to move on with life after the patient's death compared with people who did not have access to these services.Hospice care continues to evolve as its reach expands and the needs of patients continue to broaden. This is reflected in the transition from hospice being based on excellence in nursing to teams with a broad range of health professionals to meet the complex and changing needs of patients and their families. Additional integration of cancer services with hospice care will help to provide more seamless care for patients and supporting family caregivers during their caregiving and after the death of the patient.
患者在生命末期看重的因素包括尽可能长时间保持身体独立、良好的症状控制以及与朋友和家人共度美好时光。临终关怀可以提高癌症患者及其家属的护理质量,并满足这些以患者为中心的优先事项,使其在生命的最后几周和几天里受益。来自大型观察性研究的证据表明,临终关怀可以直接改善结局,并为癌症晚期患者提供更好和更适当的医疗保健服务。以团队为基础的社区临终关怀对患者、其家庭照顾者和卫生服务都有可衡量的益处。除了患者的症状控制得到改善,并且更有可能在家中度过生命的最后时光外,当患者获得临终关怀时,照顾者的结局也会更好:他们的信息需求得到更好的满足,并且与那些无法获得这些服务的人相比,照顾者在患者去世后更有能力继续生活。随着临终关怀服务的覆盖面扩大以及患者需求的不断扩大,它也在不断发展。这反映在从以护理卓越为基础的临终关怀向拥有广泛医疗专业人员的团队的转变,以满足患者及其家庭不断变化的复杂需求。临终关怀与癌症服务的进一步整合将有助于为患者及其支持的家庭照顾者在照顾期间和患者去世后提供更顺畅的护理。