University of Alabama at Birmingham, Birmingham, AL.
J Clin Oncol. 2020 Mar 20;38(9):963-973. doi: 10.1200/JCO.18.02432. Epub 2020 Feb 5.
Mounting evidence supports oncology organizations' recommendations of early palliative care as a cancer care best practice for patients with advanced cancer and/or high symptom burden. However, few trials on which these best practices are based have included rural and remote community-based oncology care. Therefore, little is known about whether early palliative care models are applicable in these low-resource areas. This literature synthesis identifies some of the challenges of integrating palliative care in rural and remote cancer care. Prominent themes include being mindful of rural culture; adapting traditional geographically based specialty care delivery models to under-resourced rural practices; and using novel palliative care education delivery methods to increase community-based health professional, layperson, and family palliative expertise to account for limited local specialty palliative care resources. Although there are many limitations, many rural and remote communities also have strengths in their capacity to provide high-quality care by capitalizing on close-knit, committed community practitioners, especially if there are receptive local palliative and hospice care champions. Hence, adapting palliative care models, using culturally appropriate novel delivery methods, and providing remote education and support to existing community providers are promising advances to aid rural people to manage serious illness and to die in place. Reformulating health policy and nurturing academic-community partnerships that support best practices are critical components of providing early palliative care for everyone everywhere.
越来越多的证据支持肿瘤学组织的建议，即把姑息治疗作为晚期癌症和/或高症状负担患者的癌症护理最佳实践。然而，这些最佳实践所依据的试验很少包括农村和偏远地区的社区肿瘤学护理。因此，对于姑息治疗模式是否适用于这些资源匮乏的地区，我们知之甚少。本文对整合姑息治疗在农村和偏远地区癌症护理方面的一些挑战进行了文献综述。突出的主题包括关注农村文化；调整传统的基于地理的专业护理提供模式，以适应资源匮乏的农村实践；以及采用新的姑息治疗教育提供方法，提高基于社区的卫生专业人员、非专业人员和家庭的姑息治疗专业知识，以弥补当地有限的专业姑息治疗资源。尽管存在许多限制，但许多农村和偏远社区也有能力通过利用紧密联系、坚定的社区从业者提供高质量的护理，特别是如果有接受当地姑息治疗和临终关怀的拥护者。因此，调整姑息治疗模式，采用文化上合适的新的提供方法，并为现有社区提供者提供远程教育和支持，是帮助农村居民管理严重疾病和就地死亡的有希望的进展。重新制定卫生政策和培养支持最佳实践的学术-社区伙伴关系，是在任何地方为每个人提供早期姑息治疗的关键组成部分。
