Gonçalves Barbara, Radojičić Tamara, Centeno Carlos, Garralda Eduardo, Martínez Marina, Preston Nancy, Hasselaar Jeroen, Arantzamendi María
Institute for Culture and Society-ATLANTES Global Observatory of Palliative Care, IdISNA- Instituto de Investigación Sanitaria de Navarra, University of Navarra, Pamplona, Spain.
Clínica Universidad de Navarra, Pamplona, Spain.
BMC Palliat Care. 2025 Jul 26;24(1):215. doi: 10.1186/s12904-025-01819-x.
Patients with advanced cancer often experience difficult symptoms near the end of life, yet the beneficial integration of oncology and palliative care is frequently lacking or poorly coordinated. Transitioning from curative treatments to palliative care focused on symptom relief and quality of life remains a common challenge. Palliative care is often underused or introduced late in the cancer treatment process, leading to suboptimal care outcomes. Understanding the factors influencing this transition is crucial for improving patients' overall care experience. This review aims to explore barriers and facilitators involved in a comprehensive transition process from oncology to palliative care of patients with advanced cancer.
This integrative review explored empirical research from 2010 to 2023 sourced from PubMed, PsycINFO, CINAHL and Cochrane databases, adhering to PRISMA guidelines. Search strategy combined concepts of advanced cancer, transition in palliative care, palliative care, and barriers and facilitators. Blind review software facilitated article selection based on criteria, with data extracted using a predefined sheet. Themes were identified through inductive thematic analysis.
38 studies met inclusion criteria out of 180 screened records. These studies were conducted in 13 countries and data collection methods ranged from interviews and focus groups to surveys and analysis of electronic medical records. In the analysis, six key themes emerged: (1) knowledge and understanding about the disease trajectory and palliative care, (2) cultural aspects of providing palliative care, (3) shortcomings in economic coverage for services, (4) characteristics of the patients' clinical situation, (5) relational dynamics between patients and professionals and among professionals and (6) organisational issues involving limitations and fragmentation of care.
This review highlights the multifaceted factors affecting the transition to palliative care. Addressing these challenges requires improvements in communication, cultural competence, financial support and organisational structure. Effective integration of palliative care into oncology practices requires collaboration among various stakeholders, including healthcare professionals, policymakers, patients, and caregivers. Through enhanced education initiatives, a more patient-centric approach to managing advanced cancer can be achieved.
晚期癌症患者在生命末期常常经历各种棘手的症状，但肿瘤学与姑息治疗的有效整合却常常缺失或协调不佳。从根治性治疗过渡到以缓解症状和提高生活质量为重点的姑息治疗仍是一项常见挑战。姑息治疗在癌症治疗过程中常常未得到充分利用或引入较晚，导致护理效果不理想。了解影响这一过渡的因素对于改善患者的整体护理体验至关重要。本综述旨在探讨晚期癌症患者从肿瘤学向姑息治疗全面过渡过程中涉及的障碍和促进因素。
本整合性综述依据PRISMA指南，对2010年至2023年来自PubMed、PsycINFO、CINAHL和Cochrane数据库的实证研究进行了探索。检索策略结合了晚期癌症、姑息治疗过渡、姑息治疗以及障碍和促进因素等概念。盲审软件根据标准协助进行文章筛选，使用预定义表格提取数据。通过归纳主题分析确定主题。
在180篇筛选记录中，有38项研究符合纳入标准。这些研究在13个国家开展，数据收集方法包括访谈、焦点小组、调查以及电子病历分析。分析中出现了六个关键主题：（1）对疾病轨迹和姑息治疗的知识与理解；（2）提供姑息治疗的文化方面；（3）服务经济覆盖范围的不足；（4）患者临床状况的特征；（5）患者与专业人员之间以及专业人员之间的关系动态；（6）涉及护理局限性和碎片化的组织问题。
本综述强调了影响向姑息治疗过渡的多方面因素。应对这些挑战需要在沟通、文化能力、财政支持和组织结构方面加以改进。将姑息治疗有效整合到肿瘤学实践中需要包括医疗保健专业人员、政策制定者、患者和护理人员在内的各利益相关者之间的合作。通过加强教育举措，可以实现更以患者为中心的晚期癌症管理方法。
