Department of Nursing, School of Medicine and Health Sciences (B.G-F., C.M-R.), Universitat Internacional de Catalunya, Sant Cugat del Vallés (Barcelona), Spain.
School of Medicine and Health Sciences (D.P., J.J-T., D.M-A., J.P-S., A.B.), Universitat Internacional de Catalunya, Sant Cugat del Vallés (Barcelona), Spain.
J Pain Symptom Manage. 2023 Oct;66(4):361-369.e6. doi: 10.1016/j.jpainsymman.2023.07.011. Epub 2023 Jul 17.
Ensuring patient-centered palliative care requires a comprehensive assessment of needs beginning in the initial encounter. However, there is no generally accepted guide for carrying out this multidimensional needs assessment as a first step in palliative intervention.
To develop an expert panel-endorsed interview guide that would enable proactive and systematic Multidimensional needs Assessment in the Palliative care initial encounter (MAP).
A preliminary version of the MAP guide was drafted based on a published literature review, published semistructured interviews with 20 patients, 20 family carers, and 20 palliative care professionals, and a nominal group process with palliative care professionals and a representative of the national patient's association. Consensus regarding its content was obtained through a modified Delphi process involving a panel of palliative care physicians from across Spain.
The published systematic literature review and qualitative study resulted in the identification of 55 needs, which were sorted and grouped by the nominal group. Following the Delphi process, the list of needs was reduced to 47, linked to six domains: Clinical history and medical conditions (n = 8), Physical symptoms (n = 17), Functional and cognitive status (n = 4), Psycho-emotional symptoms (n = 5), Social issues (n = 8), and Spiritual and existential concerns (n = 5).
MAP is an expert panel-endorsed semi-structured clinical interview guide for the comprehensive, systematic, and proactive initial assessment to efficiently assess multiple domains while adjusting to the needs of each patient. A future study will assess the feasibility of using the MAP guide within the timeframe of the palliative care initial encounter.
确保以患者为中心的姑息治疗需要在初次接诊时全面评估需求。然而，目前还没有普遍接受的指南来进行这种多维需求评估，作为姑息干预的第一步。
制定一个经过专家小组认可的访谈指南，使姑息治疗初始接诊时能够进行主动和系统的多维需求评估（MAP）。
根据已发表的文献综述、对 20 名患者、20 名家庭照顾者和 20 名姑息治疗专业人员的已发表半结构式访谈，以及与姑息治疗专业人员和国家患者协会代表的名义小组过程，初步起草了 MAP 指南。通过涉及来自西班牙各地的姑息治疗医生小组的改良 Delphi 流程，获得了对其内容的共识。
已发表的系统文献综述和定性研究导致确定了 55 项需求，这些需求通过名义小组进行了分类和分组。经过 Delphi 流程，需求清单被缩减至 47 项，与六个领域相关联：临床病史和医疗状况（n=8）、身体症状（n=17）、功能和认知状态（n=4）、心理情绪症状（n=5）、社会问题（n=8）和精神和存在问题（n=5）。
MAP 是一个经过专家小组认可的半结构化临床访谈指南，用于全面、系统和主动的初始评估，以便有效地评估多个领域，同时根据每个患者的需求进行调整。未来的研究将评估在姑息治疗初始接诊的时间框架内使用 MAP 指南的可行性。
