Romanò Massimo
Interdepartmenntal University Research Center for Palliative Care, Universityof Milan, 7-20122 Milan, Italy.
Healthcare (Basel). 2020 Feb 7;8(1):36. doi: 10.3390/healthcare8010036.
Palliative care is indicated in patients with heart failure since the early phases of the disease, as suggested by international guidelines. However, patients are referred to palliative care very late. Many barriers could explain the gap between the guidelines' indications and clinical practice. The term palliative is perceived as a stigma by doctors, patients, and family members because it is charged with negative meanings, a poor prognosis, and no hope for improvement. Many authors prefer the term supportive care, which could facilitate a discussion between doctors, patients, and caregivers. There is substantial variation and overlap in the meanings assigned to these two terms in the literature. Prognosis, as the main indication to palliative care, delays its implementation. It is necessary to modify this paradigm, moving from prognosis to patients' needs. The lack of access to palliative care programs is often due to a lack of palliative care specialists and this shortage will be greater in the near future. In this study, a new model is proposed to integrate early over the course of the disease the palliative care (PC) specialist in the heart failure team, allowing to overcome the barriers and to achieve truly simultaneous care in the treatment of heart failure (HF) patients.
正如国际指南所建议的，在心力衰竭患者疾病的早期阶段就应提供姑息治疗。然而，患者往往很晚才被转诊至姑息治疗。许多障碍可以解释指南建议与临床实践之间的差距。“姑息”一词被医生、患者和家属视为一种耻辱，因为它带有负面含义、预后不良且没有改善的希望。许多作者更喜欢“支持性护理”这个术语，它可以促进医生、患者和护理人员之间的讨论。文献中赋予这两个术语的含义存在很大差异和重叠。预后作为姑息治疗的主要指征，延迟了其实施。有必要改变这种模式，从依据预后转向依据患者需求。难以获得姑息治疗项目往往是由于缺乏姑息治疗专家，而且在不久的将来这种短缺情况会更加严重。在本研究中，提出了一种新的模式，在疾病过程早期将姑息治疗（PC）专家纳入心力衰竭治疗团队，以克服障碍并在心力衰竭（HF）患者的治疗中真正实现同步护理。
