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重新定义姑息治疗——基于共识的新定义

Redefining Palliative Care-A New Consensus-Based Definition.

作者信息

Radbruch Lukas, De Lima Liliana, Knaul Felicia, Wenk Roberto, Ali Zipporah, Bhatnaghar Sushma, Blanchard Charmaine, Bruera Eduardo, Buitrago Rosa, Burla Claudia, Callaway Mary, Munyoro Esther Cege, Centeno Carlos, Cleary Jim, Connor Stephen, Davaasuren Odontuya, Downing Julia, Foley Kathleen, Goh Cynthia, Gomez-Garcia Wendy, Harding Richard, Khan Quach T, Larkin Phillippe, Leng Mhoira, Luyirika Emmanuel, Marston Joan, Moine Sebastien, Osman Hibah, Pettus Katherine, Puchalski Christina, Rajagopal M R, Spence Dingle, Spruijt Odette, Venkateswaran Chitra, Wee Bee, Woodruff Roger, Yong Jinsun, Pastrana Tania

机构信息

Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.

International Association for Hospice and Palliative Care, Houston, Texas, USA.

出版信息

J Pain Symptom Manage. 2020 Oct;60(4):754-764. doi: 10.1016/j.jpainsymman.2020.04.027. Epub 2020 May 6.

Abstract

CONTEXT

The International Association for Hospice and Palliative Care developed a consensus-based definition of palliative care (PC) that focuses on the relief of serious health-related suffering, a concept put forward by the Lancet Commission Global Access to Palliative Care and Pain Relief.

OBJECTIVE

The main objective of this article is to present the research behind the new definition.

METHODS

The three-phased consensus process involved health care workers from countries in all income levels. In Phase 1, 38 PC experts evaluated the components of the World Health Organization definition and suggested new/revised ones. In Phase 2, 412 International Association for Hospice and Palliative Care members in 88 countries expressed their level of agreement with the suggested components. In Phase 3, using results from Phase 2, the expert panel developed the definition.

RESULTS

The consensus-based definition is as follows: Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers. The definition includes a number of bullet points with additional details as well as recommendations for governments to reduce barriers to PC.

CONCLUSION

Participants had significantly different perceptions and interpretations of PC. The greatest challenge faced by the core group was trying to find a middle ground between those who think that PC is the relief of all suffering and those who believe that PC describes the care of those with a very limited remaining life span.

摘要

背景

国际临终关怀与姑息治疗协会制定了基于共识的姑息治疗(PC)定义,该定义聚焦于缓解与健康相关的严重痛苦,这是《柳叶刀》全球姑息治疗与疼痛缓解委员会提出的一个概念。

目的

本文的主要目的是介绍新定义背后的研究。

方法

三阶段共识达成过程涉及来自所有收入水平国家的医护人员。在第一阶段,38名姑息治疗专家评估了世界卫生组织定义的组成部分,并提出了新的/修订后的组成部分。在第二阶段,来自88个国家的412名国际临终关怀与姑息治疗协会成员表达了他们对所建议组成部分的认同程度。在第三阶段,专家小组利用第二阶段的结果制定了该定义。

结果

基于共识的定义如下:姑息治疗是对所有年龄段因重病而遭受与健康相关严重痛苦的个人,尤其是对那些接近生命末期的个人进行的积极全面护理。其旨在提高患者、其家人及其护理人员的生活质量。该定义包括一些带有更多细节的要点以及政府减少姑息治疗障碍的建议。

结论

参与者对姑息治疗的认知和理解存在显著差异。核心小组面临的最大挑战是在那些认为姑息治疗是缓解所有痛苦的人和那些认为姑息治疗是对剩余寿命非常有限的人进行护理的人之间找到一个中间立场。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2633/8096724/30f3b846f7bd/nihms-1694235-f0001.jpg

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