University of Texas MD Anderson Cancer Center, Houston, TX.
J Clin Oncol. 2020 Mar 20;38(9):852-865. doi: 10.1200/JCO.18.02123. Epub 2020 Feb 5.
Palliative care has evolved over the past five decades as an interprofessional specialty to improve quality of life and quality of care for patients with cancer and their families. Existing evidence supports that timely involvement of specialist palliative care teams can enhance the care delivered by oncology teams. This review provides a state-of-the-science synopsis of the literature that supports each of the five clinical models of specialist palliative care delivery, including outpatient clinics, inpatient consultation teams, acute palliative care units, community-based palliative care, and hospice care. The roles of embedded clinics, nurse-led models, telehealth interventions, and primary palliative care also will be discussed. Outpatient clinics represent the key point of entry for timely access to palliative care. In this setting, patient care can be enhanced longitudinally through impeccable symptom management, monitoring, education, and advance care planning. Inpatient consultation teams provide expert symptom management and facilitate discharge planning for acutely symptomatic hospitalized patients. Patients with the highest level of distress and complexity may benefit from an admission to acute palliative care units. In contrast, community-based palliative care and hospice care are more appropriate for patients with a poor performance status and low to moderate symptom burden. Each of these five models of specialist palliative care serve a different patient population along the disease continuum and complement one another to provide comprehensive supportive care. Additional research is needed to define the standards for palliative care interventions and to refine the models to further improve access to quality palliative care.
姑息治疗在过去的五十年中发展成为一个跨专业的专业领域，旨在提高癌症患者及其家属的生活质量和护理质量。现有证据支持，及时引入专科姑息治疗团队可以增强肿瘤团队的护理效果。本综述提供了支持专科姑息治疗五种临床模式的文献的最新概述，包括门诊、住院会诊团队、急性姑息治疗病房、基于社区的姑息治疗和临终关怀。嵌入式诊所、护士主导的模式、远程医疗干预和初级姑息治疗的作用也将进行讨论。门诊代表了及时获得姑息治疗的关键切入点。在这种情况下，通过无可挑剔的症状管理、监测、教育和预先护理计划，可以从长远角度加强患者护理。住院会诊团队为急性症状住院患者提供专家症状管理和促进出院计划。对于最痛苦和最复杂的患者，可能需要入住急性姑息治疗病房。相比之下，基于社区的姑息治疗和临终关怀更适合身体状况不佳和症状负担低至中度的患者。这五种专科姑息治疗模式中的每一种都服务于疾病连续体中的不同患者群体，并相互补充，提供全面的支持性护理。需要进一步的研究来定义姑息治疗干预的标准，并完善这些模式，以进一步改善获得高质量姑息治疗的机会。
