Han Harry J, Yeh Jonathan C, McNichol Megan, Buss Mary K
Section of Palliative Care, Division of General Medicine and Primary Care (H.J.H., J.C.Y.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Section of Palliative Care, Division of General Medicine and Primary Care (H.J.H., J.C.Y.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
J Pain Symptom Manage. 2023 Feb;65(2):e137-e153. doi: 10.1016/j.jpainsymman.2022.09.016. Epub 2022 Oct 13.
Early, longitudinal integration of palliative care (PC) is recommended for patients with advanced cancer, in both inpatient and outpatient settings. Despite the growth of specialty PC teams in the last decade, the majority of PC is still delivered in the inpatient setting using a traditional referral-based consult delivery model. However, traditional consultation can lead to significant variation or delay in inpatient PC utilization. New care delivery models and strategies are emerging to deliver PC to hospitalized oncology patients who would most benefit from their services and to better align with professional society recommendations.
To identify different care models to deliver PC to ho`spitalized oncology patients and summarize their impact on patient and health system-related outcomes.
We conducted a scoping review of peer-reviewed articles from 2006 to 2021 evaluating delivery of PC to oncology patients in acute inpatient care. We abstracted study characteristics, the study's intervention and comparison arms, and outcomes related to specialty PC intervention.
We identified four delivery models that have been reported to deliver PC: 1) traditional referral-based consultation, 2) criterion-based or "triggered" consultation, 3) co-rounding with primary inpatient team, and 4) PC clinicians serving as the primary team. We summarize the known outcomes data from each model, and compare the benefits and limitations of each model.
Our findings provide guidance to health systems about care delivery models to deploy and implement inpatient PC resources to best serve their unique populations.
对于晚期癌症患者，建议在住院和门诊环境中尽早进行姑息治疗（PC）的纵向整合。尽管在过去十年中专科姑息治疗团队有所增加，但大多数姑息治疗仍在住院环境中采用传统的基于转诊的会诊模式。然而，传统会诊可能导致住院姑息治疗利用方面的显著差异或延迟。新的护理模式和策略正在出现，以便为最能从其服务中受益的住院肿瘤患者提供姑息治疗，并更好地符合专业协会的建议。
确定为住院肿瘤患者提供姑息治疗的不同护理模式，并总结其对患者及与卫生系统相关结局的影响。
我们对2006年至2021年期间评估急性住院护理中为肿瘤患者提供姑息治疗的同行评审文章进行了范围综述。我们提取了研究特征、研究的干预组和对照组，以及与专科姑息治疗干预相关的结局。
我们确定了四种已报道的提供姑息治疗的模式：1）传统的基于转诊的会诊；2）基于标准或“触发式”会诊；3）与住院初级团队共同查房；4）姑息治疗临床医生担任主要团队。我们总结了每种模式已知的结局数据，并比较了每种模式的优缺点。
我们的研究结果为卫生系统在部署和实施住院姑息治疗资源以最好地服务其独特人群方面提供了护理模式的指导。
