Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland.
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Clin Adv Hematol Oncol. 2021 Jun;19(6):390-395.
The provision of specialty palliative care alongside oncology care is now recommended by the American Society of Clinical Oncology (ASCO) on the basis of multiple randomized trials showing that it leads to better symptom control, less depression and anxiety, improved quality of life, improved caregiver quality of life, and even longer survival. That said, simply not enough palliative care specialists are available to provide concurrent care, so oncologists are tasked with providing the greatest part of primary palliative care. It is useful to think of primary palliative care as comprising 2 skill sets, or "bundles": the first symptom assessment and management, and the second communication. Symptom assessment begins with the use of a standardized scale that emphasizes the assessment of anxiety, depression, physical symptoms, and coping strategies. Communication requires knowing how much information the patient and family want, especially about prognosis, and involves shared decision making. It also encompasses advance care planning, starting with the identification of a medical power of attorney and proceeding to a discussion about hospice and end-of-life treatment choices. The communication skill set includes providing caregiver support and spiritual care referral, making culturally appropriate decisions, and providing a specific statement of non-abandonment near the end of life. If specialty palliative care is involved, data show that the effect on quality of life and end-of-life choices is most meaningful if consultation is started at least 3 months before death. In this article, we provide a brief overview of the benefits of incorporating palliative care into routine oncologic practice and offer clinical pearls on how best to deliver the tenets of palliative care in the outpatient and inpatient settings.
现在，美国临床肿瘤学会（ASCO）建议在肿瘤学治疗的基础上提供专业的姑息治疗，这是基于多项随机试验的结果，这些试验表明姑息治疗可改善症状控制、减少抑郁和焦虑、提高生活质量、改善照护者的生活质量，甚至延长生存时间。也就是说，提供姑息治疗的专业人员仍然不足，无法提供同步治疗，因此肿瘤学家的任务是提供大部分初级姑息治疗。将初级姑息治疗视为包含 2 种技能或“套餐”是有用的：第一种是症状评估和管理，第二种是沟通。症状评估始于使用强调评估焦虑、抑郁、身体症状和应对策略的标准化量表。沟通需要了解患者和家属想要多少信息，尤其是关于预后的信息，并涉及共同决策。它还包括预先护理计划，从确定医疗授权书开始，然后讨论临终关怀和临终治疗选择。沟通技能包括为照护者提供支持和精神关怀转诊、做出符合文化的决策，以及在生命末期提供不放弃的明确声明。如果涉及专业姑息治疗，数据表明，如果在死亡前至少 3 个月开始咨询，对生活质量和临终选择的影响最有意义。在本文中，我们简要概述了将姑息治疗纳入常规肿瘤学实践的益处，并提供了在门诊和住院环境中最好地提供姑息治疗原则的临床要点。
