Palliative Medicine, St Raphael's Hospice, Cheam, UK
Palliative Medicine, Princess Alice Hospice, Esher, UK.
BMJ Support Palliat Care. 2020 Sep;10(3):331-336. doi: 10.1136/bmjspcare-2020-002498. Epub 2020 Jul 17.
While the additional value from adding the option of virtual visits is not in question, numerous issues are raised around how to decide between face-to-face and virtual visits in individual cases and how best to set up such provision within an organisation. With only limited palliative care-specific literature and no time to set up and evaluate pilots, we had to get on and set up a prototype 'virtual visits' model, retro-fitting guidance and a supporting ethical framework. We looked at the issues spanning clinical, ethical and logistics domains; identifying areas of benefit as well as drawbacks, some specific to the rushed implementation because of COVID-19's infective risks and the 'rules' of lockdown, but many are generic areas to help guide longer term service design. Unsurprisingly, it appears clear that a 'one-size-fits-all' mentality is a poor fit for the individualised needs of the heterogeneous palliative care population. Virtual visits have great potential even if they are not a panacea.
虽然增加虚拟访问选项的额外价值是毋庸置疑的，但在个别情况下，如何在面对面访问和虚拟访问之间做出决策，以及如何在组织内最好地设置这种服务，存在着诸多问题。由于姑息治疗方面的专门文献有限，也没有时间来设立和评估试点，我们不得不着手建立一个虚拟访问的原型模型，同时制定指导方针和支持性伦理框架。我们研究了跨越临床、伦理和物流领域的问题；确定了受益领域和不足之处，其中一些是由于 COVID-19 的感染风险和封锁规则而仓促实施所特有的，但许多是通用领域，可以帮助指导更长期的服务设计。毫不奇怪，对于姑息治疗这一异质人群来说，“一刀切”的心态显然不适合个性化需求。即使虚拟访问不是万能的，但它也有很大的潜力。
