Duke Cancer Institute, Durham, NC.
Ludwig-Maximilians University (LMU) Hospital, LMU Munich, Munich, Germany.
J Clin Oncol. 2020 Mar 20;38(9):987-994. doi: 10.1200/JCO.18.02440. Epub 2020 Feb 5.
Although robust evidence demonstrates that specialty palliative care integrated into oncology care improves patient and health system outcomes, few clinicians are familiar with the standards, guidelines, and quality measures related to integration. These types of guidance outline principles of best practice and provide a framework for assessing the fidelity of their implementation. Significant advances in the understanding of effective methods and procedures to guide integration of specialty palliative care into oncology have led to a proliferation of guidance documents around the world, with several areas of commonality but also some key differences. Commonalities originate from a shared vision for integration; differences arise from diverse roles of palliative care specialists within cancer care globally. In this review we discuss three of the most cited standards/guidelines, as well as quality measures related to integrated palliative and oncology care. We also recommend changes to the quality measurement framework for palliative care and a new way to match palliative care services to patients with advanced cancer on the basis of care complexity and patient needs, irrespective of prognosis.
尽管有强有力的证据表明,将肿瘤学专科姑息治疗与常规治疗相结合能够改善患者和医疗系统的预后,但只有少数临床医生熟悉相关的标准、指南和质量指标。这些类型的指南概述了最佳实践的原则,并为评估其实施的一致性提供了框架。对有效方法和程序的理解取得了重大进展,这些方法和程序可指导将肿瘤学专科姑息治疗纳入其中,从而在全球范围内产生了大量的指导文件,这些文件既有共同之处,也有一些关键的差异。共同之处源于整合的共同愿景;差异则源于全球癌症护理中姑息治疗专家的不同角色。在这篇综述中,我们讨论了三个最常被引用的标准/指南,以及与姑息治疗和肿瘤学整合相关的质量措施。我们还建议对姑息治疗的质量衡量框架进行修改,并建议根据护理的复杂性和患者的需求,为患有晚期癌症的患者匹配合适的姑息治疗服务,而不考虑预后。