Maltoni M, Nanni O, Naldoni M, Serra P, Amadori D
Pierantoni Hospital, Medical Oncology Department, Forli, Italy.
Curr Opin Oncol. 1998 Jul;10(4):302-9. doi: 10.1097/00001622-199807000-00005.
Palliative care and palliative medicine embrace the philosophy and the body of knowledge regarding the correct treatment of patients with terminal disease. Palliative treatments can be delivered intramurally (eg, in a hospice or palliative care unit) or at home (home care hospice). The optimal delivery pattern consists of the co-utilization of both care settings, to allow patients who need palliative, supportive, and terminal care to benefit from each setting. In obtaining the available resources, health service costs in Western countries have lately become exorbitant. Home care hospice is a system capable of defeating the challenge on two fronts: to meet the patients' needs and to fulfill this task through economically advantageous practices. Home care hospice is undoubtedly more cost-effective than conventional or generic home care, conventional care (hospitalization), and inpatient hospice care. Its advantage is more evident in the last 3 months of life, due to shorter hospitalization and nonutilization of high-technology interventions and high-cost drugs. The development of a range of palliative care programs integrating primary territorial care and specialized palliative services can constitute the ideal synthesis to respond to patients' needs in a threefold manner: firstly, the patient's right to qualified palliative and terminal care; secondly, the requirements of health services, and lastly, cost containment through a correct and tailored use of available resources.
姑息治疗和姑息医学涵盖了关于终末期疾病患者正确治疗的理念和知识体系。姑息治疗可以在机构内提供（例如，在临终关怀机构或姑息治疗病房），也可以在家中提供（居家临终关怀）。最佳的提供模式是同时利用这两种护理环境，以使需要姑息、支持和终末期护理的患者从每种环境中受益。在获取可用资源方面，西方国家的医疗服务成本最近变得过高。居家临终关怀是一种能够在两个方面应对挑战的系统：满足患者需求，并通过经济上有利的做法完成这项任务。居家临终关怀无疑比传统的或一般的居家护理、传统护理（住院治疗）和住院临终关怀护理更具成本效益。由于住院时间较短，且不使用高科技干预措施和高成本药物，其优势在生命的最后3个月更为明显。一系列整合基层地区护理和专业姑息服务的姑息治疗项目的发展，可以构成一种理想的综合模式，以三种方式满足患者的需求：第一，患者获得合格的姑息和终末期护理的权利；第二，医疗服务的要求；最后，通过正确和有针对性地利用可用资源来控制成本。
