Department of Supportive Care, University Health Network, Toronto, Canada.
Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada.
Curr Treat Options Oncol. 2023 Apr;24(4):353-372. doi: 10.1007/s11864-023-01060-9. Epub 2023 Mar 13.
While the benefits of early palliative care are indisputable, most of the current evidence has emerged from resource-rich settings in urban areas of high-income countries, with an emphasis on solid tumors in outpatient settings; this model of palliative care integration is not currently scalable internationally. A shortage of specialist palliative care clinicians means that in order to meet the needs of all patients who require support at any point along their advanced cancer trajectory, palliative care must also be provided by family physicians and oncology clinicians who require training and mentorship. Models of care that facilitate the timely provision of seamless palliative care across all settings (inpatient, outpatient, and home-based care), with clear communication between clinicians, are crucial to the provision of patient-centred palliative care. The unique needs of patients with hematological malignancies must be further explored and existing models of palliative care provision modified to meet these needs. Finally, care must be provided in an equitable and culturally sensitive manner, recognizing the challenges associated with the delivery of high-quality palliative care to both patients in high-income countries who live in rural areas, as well as to those in low- and middle-income countries. A one-size-fits-all model will not suffice, and there is an urgent need to develop innovative context-specific models of palliative care integration worldwide, in order to provide the right care, in the right place, and at the right time.
虽然早期姑息治疗的益处是不可争议的,但目前大多数证据都来自资源丰富的高收入国家城市地区的门诊环境中,重点是实体肿瘤;这种姑息治疗整合模式目前在国际上无法推广。姑息治疗专家的短缺意味着,为了满足所有在晚期癌症病程中任何阶段需要支持的患者的需求,姑息治疗也必须由家庭医生和肿瘤学临床医生提供,他们需要接受培训和指导。在所有环境(住院、门诊和家庭护理)中提供无缝姑息治疗的护理模式,并在临床医生之间进行清晰的沟通,对于提供以患者为中心的姑息治疗至关重要。必须进一步探索血液恶性肿瘤患者的独特需求,并修改现有的姑息治疗提供模式以满足这些需求。最后,必须以公平和文化敏感的方式提供护理,认识到向高收入国家居住在农村地区的患者以及中低收入国家的患者提供高质量姑息治疗所带来的挑战。一刀切的模式是不够的,迫切需要在全球范围内制定创新的、特定于背景的姑息治疗整合模式,以便在适当的时间、在适当的地点提供适当的护理。