Mochamat Mochamat, Przyborek Marta, Jaspers Birgit, Cuhls Henning, Conrad Rupert, Mücke Martin, Radbruch Lukas
Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany.
Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Diponegoro University Semarang, Indonesia, Germany.
Indian J Palliat Care. 2023 Jul-Sep;29(3):256-265. doi: 10.25259/IJPC_194_2022. Epub 2023 Jan 11.
Fatigue is a frequent and burdensome symptom in patients with advanced disease in palliative care. However, it is under-assessed and undertreated in clinical practice, even though many treatment options have been identified in systematic reviews. Care pathways with defined and standardised steps have been recommended for effective management in the clinical setting. This paper describes a care pathway for managing fatigue in palliative care patients. This study aims to develop a care pathway with detailed guidance for screening, assessment, diagnosis, and treatment of fatigue in palliative care patients.
A collaborative effort of multidisciplinary clinicians participated in constructing the care pathway. The care pathway was developed using the following steps: (a) Developing an intervention; (b) piloting and feasibility; (c) evaluating the intervention; (d) reporting; and (e) implementation. This paper covers the first step, which includes the evidence base identification, theory identification/development, and process/outcomes modeling. A literature search was conducted to understand the extent of the fatigue problem in the palliative care setting and identify existing guidelines and strategies for managing fatigue. Consistent recommendations emanating from the included papers were then contributed to a care pathway. Patient representatives and palliative care professionals provided feedback on the draft.
The care pathway address the following care processes: (1) Screening for the presence of fatigue; (2) assessment to evaluate the severity of fatigue; (3) diagnostic procedure, including history, physical examination, and laboratory finding; (4) therapeutic management pathway for clinical decision-making; and (5) valuation of treatment effect, using questionnaires, diaries and physical activity monitoring with body-worn sensors.
The development of a care pathway will help to implement regular and structured assessment, diagnosis, and treatment of fatigue for healthcare professionals treating palliative care patients. Reviewing the pathway with a multidisciplinary expert group and field testing the pathway will be the next steps toward implementation.
疲劳是姑息治疗中晚期疾病患者常见且负担沉重的症状。然而，尽管在系统评价中已确定了许多治疗方案，但在临床实践中对其评估不足且治疗不充分。推荐采用具有明确和标准化步骤的护理路径，以便在临床环境中进行有效管理。本文描述了一种用于管理姑息治疗患者疲劳的护理路径。本研究旨在开发一种护理路径，为姑息治疗患者疲劳的筛查、评估、诊断和治疗提供详细指导。
多学科临床医生共同参与构建护理路径。护理路径的开发采用以下步骤：(a)制定干预措施；(b)试点与可行性研究；(c)评估干预措施；(d)报告；(e)实施。本文涵盖第一步，包括证据基础识别、理论识别/发展以及过程/结果建模。进行文献检索以了解姑息治疗环境中疲劳问题的程度，并确定现有的管理疲劳的指南和策略。然后将纳入论文中一致的建议纳入护理路径。患者代表和姑息治疗专业人员对草案提供了反馈。
该护理路径涵盖以下护理过程：(1)筛查疲劳的存在；(2)评估以评估疲劳的严重程度；(3)诊断程序，包括病史、体格检查和实验室检查结果；(4)用于临床决策的治疗管理路径；(5)使用问卷、日记和身体佩戴传感器进行身体活动监测来评估治疗效果。
护理路径的开发将有助于为治疗姑息治疗患者的医护人员实施对疲劳的定期和结构化评估、诊断及治疗。与多学科专家组一起审查该路径并对其进行实地测试将是迈向实施的下一步。
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