Palliative Care Unit, University of Liverpool, Liverpool, UK.
The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.
Palliat Med. 2023 Mar;37(3):329-342. doi: 10.1177/02692163231152523. Epub 2023 Feb 3.
Good care of the dying has been defined as being able to die in the place of your choice, free from pain, cared for with dignity and supported by the best possible care. This definition underpinned the development of the '10/40 Model' of care for the dying, in 2013. The model includes 10 'Key Principles' that underpin 40 'Core Outcomes' of care. It was necessary to update consensus on the 10/40 Model to ensure that it remains clinically relevant and applicable for practice.
Update international consensus on the content of the 10/40 Model.
Delphi study utilising questionnaire completion; each round informed the need for, and content of the next. Free text comments were also sought. Three rounds of Delphi were undertaken.
SETTING/PARTICIPANTS: A total of 160 participants took part in round 1, representing 31 countries; 103 in round 2 and 57 in round 3. Participants included doctors, nurses, researchers and allied health professionals, with over 80% working predominantly in palliative care (general/specialist not specified).
Minor amendments were made to seven items related to: recognition of the dying phase, ongoing assessment of the patient's condition, communication with patients about the plan of care and care in the immediate time after the death of a patient. Results supported the addition of a sub core outcome for care provided after death.
The updated 10/40 Model will guide the delivery of high-quality care for dying patients regardless of the location of care. Further work should focus on increasing lay participation and participation from low income and culturally diverse countries.
临终关怀的定义是能够在自己选择的地点、无痛苦地、有尊严地接受护理，并得到尽可能好的护理而离世。2013 年，“10/40 模型”的临终关怀就是基于这一定义发展而来的。该模型包含 10 项“关键原则”，支撑着 40 项“核心结果”。有必要更新对 10/40 模型的共识，以确保其在临床仍然相关且适用于实践。
更新国际社会对 10/40 模型内容的共识。
利用问卷调查进行 Delphi 研究；每一轮都为下一轮的必要性和内容提供信息。还征求了自由文本评论。进行了三轮 Delphi 研究。
地点/参与者：共有 160 名参与者参加了第一轮，代表 31 个国家；103 人参加了第二轮，57 人参加了第三轮。参与者包括医生、护士、研究人员和相关健康专业人员，其中 80%以上的人主要从事姑息治疗（未具体说明一般/专科）。
对与以下内容相关的七项内容进行了小的修订：识别临终阶段、对患者病情进行持续评估、与患者沟通护理计划以及在患者死亡后立即进行护理。结果支持增加一个关于死亡后护理的核心亚结果。
更新后的 10/40 模型将指导为临终患者提供高质量的护理，无论护理地点在哪里。进一步的工作应侧重于增加非专业人士和来自低收入和文化多样国家的参与。
