Pereira José, Klinger Christopher, Seow Hsien, Marshall Denise, Herx Leonie
Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
Faculty of Medicine, University of Navarra, Pamplona, Navarra, Spain.
Palliat Med Rep. 2024 Feb 23;5(1):104-115. doi: 10.1089/pmr.2023.0079. eCollection 2024.
Primary- and specialist-level palliative care services are needed. They should work collaboratively and synergistically. Although several service models have been described, these remain open to different interpretations and deployment.
This article describes a conceptual framework, the Consultation-Shared Care-Takeover (C-S-T) Framework, its evolution and its applications.
An iterative process informed the development of the Framework. This included a symposium, literature searches, results from three studies, and real-life applications.
The C-S-T Framework represents a spectrum anchored by the model at one end, the model at the other end, and the model in the center. Indicators, divided into five domains, help differentiate one model from the other. The domains are (1) Scope (What aspects of care are addressed by the palliative care clinician?); (2) Prescriber (Who prescribes the treatments?); (3) Communication (What communication occurs between the palliative care clinician and the patient's attending clinician?); (4) Follow-up (Who provides the follow-up visits and what is their frequency?); and (5) Most responsible practitioner (MRP) (Who is identified as MRP?). Each model demonstrates strengths, limitations, uses, and roles.
The C-S-T Framework can be used to better describe, understand, assess, and monitor models being used by specialist palliative care teams in their interactions with primary care providers and other specialist services. Large studies are needed to test the application of the Framework on a broader scale in health care systems.
需要初级和专科层面的姑息治疗服务。它们应协同合作、形成合力。尽管已经描述了几种服务模式，但这些模式仍存在不同的解读和应用方式。
本文描述了一个概念框架，即咨询-共享护理-接管（C-S-T）框架、其演变过程及其应用。
一个迭代过程为该框架的开发提供了依据。这包括一次研讨会、文献检索、三项研究的结果以及实际应用。
C-S-T框架代表了一个范围，一端以 模式为锚定，另一端以 模式为锚定，中间为 模式。分为五个领域的指标有助于区分不同模式。这些领域包括：（1）范围（姑息治疗临床医生处理护理的哪些方面？）；（2）开处方者（谁开治疗处方？）；（3）沟通（姑息治疗临床医生与患者的主治临床医生之间发生何种沟通？）；（4）随访（谁提供随访以及随访频率是多少？）；以及（5）最主要负责医生（MRP）（谁被确定为MRP？）。每种模式都展示了其优势、局限性、用途和作用。
C-S-T框架可用于更好地描述、理解、评估和监测专科姑息治疗团队在与初级保健提供者及其他专科服务互动时所使用的模式。需要进行大规模研究以在医疗保健系统中更广泛地测试该框架的应用。
