基于价值评估的医疗实践: 将肿瘤康复和缓和医疗整合在癌症患者医疗服务中

doi:10.24920/003523

摘要/Abstract

摘要：

以价值体系为评估标准的医疗服务是围绕患者的疾病需求来组织和提供全周期的完整的医疗服务模式。这种全周期的医疗服务是以住院、门诊、康复设施为场地,除了传统的医疗手段,还包括缓和医疗,营养支持性治疗在内的完整的医疗计划和服务模式。肿瘤康复和缓和医疗已经开始成为肿瘤治疗计划中有重要价值的两个组成部分。越来越多的临床证据表明,疾病早期时肿瘤康复的介入和缓和医疗干预会改善患者预后并降低患者、家庭和医疗服务机构的整体医疗费用。在中国,虽然越来越多的肿瘤学专家开始关注这两个亚专科,但这两项医疗服务如何嵌入到现有医疗体制下的临床实践中,尚未得到有效性的研究和验证。医护人员深入了解肿瘤康复和缓和医疗的作用及工作范畴有助于两项服务有效融入到肿瘤治疗的延续照护计划中,以促进肿瘤患者在生理、心理、认知和功能方面的健康,提高其生活质量。

关键词: 肿瘤康复, 缓和医疗, 安宁疗护, 失能, 生活质量

Abstract:

Value-based care model has been evolving to organize medical services around the patient and provide the full cycle of care for a medical condition. The full cycle of care model encompasses inpatient, outpatient, rehabilitation as well as supportive care such as palliative care and nutrition support. Cancer rehabilitation and palliative care have emerged as two important parts of value-based practice for oncology patients. More clinical evidence suggests that early intervention of oncology rehabilitation program and palliative care are likely to improve the patient outcome and reduce the overall medical cost for the patient and his or her family as well as for medical service providers. Although interest has been raised in Chinese oncologists, but effectiveness of incorporating these two services in clinical practices has not been adequately demonstrated. An understanding of scope of cancer rehabilitation and palliative care may help facilitate the integration of both into the oncology care continuum in efforts to improve patients’ physical, psychological, cognitive, functional health and quality of life.

Key words: cancer rehabilitation, palliative care, hospice, disability, quality of life

Zhu Yi. Value-based Practice: Integration of Cancer Rehabilitation and Palliative Care in Oncology Services[J].Chinese Medical Sciences Journal, 2018, 33(4): 204-209.

参考文献 28

[1]	Curtis EB, Krech R, Walsh TD . Common symptoms in patients with advanced cancer. J Palliat Care 1991; 7(2):25-9. pmid: 1870042
[2]	Donnelly S, Walsh D . The symptoms of advanced cancer. Semin Oncol 1995; 22(2 suppl 3):67-72. doi: 10.1006/scbi.1995.0014 pmid: 7537907
[3]	Mukai A . The future of physiatry: with challenges come opportunities. PM R 2011; 3(3):189-92. doi: 10.1016/j.pmrj.2011.02.002. doi: 10.1016/j.pmrj.2011.02.002 pmid: 21402363
[4]	Bruera E, Hui D . Conceptual models for integrating palliative care at cancer centers. J Palliat Med 2012; 15(11):1261-9. doi: 10.1089/jpm.2012.0147. doi: 10.1089/jpm.2012.0147 pmid: 22925157
[5]	Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population; Board on Health Care Services; Institute of Medicine. Delivering high-quality cancer care: charting a new course for a system in crisis. Washington, DC; National Academies Press: 2013.
[6]	Marciniak CM, Sliwa JM, Spill G , et al. Functional outcome following rehabilitation of the cancer patient. Arch Phys Med Rehabil 1996; 77(1):54-7. doi: 10.1016/s0003-9993(96)90220-8. doi: 10.1016/s0003-9993(96)90220-8 pmid: 8554474
[7]	Eyigor S . Physical activity and rehabilitation programs should be recommended on palliative care for patients with cancer. J Palliat Med 2010; 13(10):1183-4. doi: 10.1089/jpm.2010.0064. doi: 10.1089/jpm.2010.0064 pmid: 20942758
[8]	Parikh RB, Kirch RA, Smith TJ , et al. Early specialty palliative care—translating data in oncology into practice. N Engl J Med 2013; 369(24):2347-51. doi: 10.1056/NEJMsb1305469. doi: 10.1056/NEJMsb1305469 pmid: 3991113
[9]	Bower JE . Cancer-related fatigue—mechanisms, risk factors, and treatments. Nat Rev Clin Oncol 2014; 11(10):597-609. doi: 10.1038/nrclinonc.2014.127. doi: 10.1038/nrclinonc.2014.127 pmid: 25113839
[10]	Jacobsen PB, Donovan KA, Vadaparampil ST , et al. Systematic review and meta-analysis of psycholo-gical and activity-based interventions for cancer-related fatigue. Health Psychol 2007; 26(6):660-7. doi: 10.1037/0278-6133.26.6.660. doi: 10.1037/0278-6133.26.6.660
[11]	Barsevick AM, Whitmer K, Sweeney C , et al. A pilot study examining energy conservation for cancer treatment-related fatigue. Cancer Nurs 2002; 25(5):333-41. doi: 10.1097/00002820-200210000-00001. doi: 10.1097/00002820-200210000-00001 pmid: 12394560
[12]	Dittus KL, Lakoski SG, Savage PD , et al. Exercise-based oncology rehabilitation: leveraging the cardiac rehabilitation model. J Cardio pulm Rehabil Prev 2015; 35(2):130-9. doi: 10.1097/HCR.0000000000000091. doi: 10.1097/HCR.0000000000000091
[13]	World Health Organization. WHO definition of palliative care. http://www.who.int/cancer/palliative/definition/en. Accessed August 30, 2018.
[14]	Dalal S, Palla S, Hui D , et al. Association between a name change from palliative to supportive care and the timing of patient referrals at a comprehensive cancer center. Oncologist 2011; 16(1):105-11. doi: 10.1634/theoncologist.2010-0161. doi: 10.1634/theoncologist.2010-0161 pmid: 21212438
[15]	Morrison RS, Augustin R, Souvanna P , et al. America’s care of serious illness: a state-by-state report card on access to palliative care in our nation’s hospitals. J Palliat Med 2011; 14(10):1094-6. doi: 10.1089/jpm.2011.9634. doi: 10.1089/jpm.2011.9634
[16]	Brumley R, Enguidanos S, Jamison P , et al. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. J Am Geriatr Soc 2007; 55(7):993-1000. doi: 10.1111/j.1532-5415. 2007.01234.x. doi: 10.1111/j.1532-5415. 2007.01234.x
[17]	Gade G, Venohr I, Conner D , et al. Impact of an inpatient palliative care team: a randomized control trial. J Palliat Med 2008; 11(2):180-90. doi: 10.1089/jpm.2007.0055. doi: 10.1089/jpm.2007.0055 pmid: 18333732
[18]	Bakitas M, Lyons KD, Hegel MT , et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the project ENABLE II randomized controlled trial. JAMA 2009; 302(7):741-9. doi: 10.1001/jama.2009.1198. doi: 10.1001/jama.2009.1198
[19]	Barawid E, Covarrubias N, Tribuzio B , et al. The benefits of rehabilitation for palliative care patients. Am J Hosp Palliat Care 2015; 32(1):34-43. doi: 10.1177/1049909113514474. doi: 10.1177/1049909113514474 pmid: 19910723820524301083
[20]	Jensen W, Bialy L, Ketels G , et al. Physical exercise and therapy in terminally ill cancer patients: a retrospective feasibility analysis. Support Care Cancer 2014; 22(5):1261-8. doi: 10.1007/s00520-013-2080-4. doi: 10.1007/s00520-013-2080-4 pmid: 24317851
[21]	Jones L, Fitzgerald G, Leurent B , et al. Rehabilitation in advanced,progressive, recurrent cancer: a randomized controlled trial. J Pain Symptom Manage 2013; 46(3):315-25. e3. doi: 10.1016/j.jpainsymman.2012.08.017, e313. doi: 10.1016/j.jpainsymman.2012.08.017 pmid: 23182307
[22]	Raj VS, Balouch J, Norton JH . Cancer rehabilitation education during physical medicine and rehabilitation residency: preliminary data regarding the quality and quantity of experiences. Am J Phys Med Rehabil 2014; 93(5):445-52. doi: 10.1097/PHM.0000000000000060. doi: 10.1097/PHM.0000000000000060 pmid: 25802963
[23]	Palacio A, Calmels P, Genty M , et al. Oncology and physical medicine and rehabilitation. Ann Phys Rehabil Med 2009; 52(7-8):568-78. doi: 10.1016/j.rehab.2009.05.004. doi: 10.1016/j.rehab.2009.05.004 pmid: 19720573
[24]	Patient Quality of Life Coalition Web site .http://patientqualityoflife.org. Accessed September 28, 2018.
[25]	Alfano CM, Smith T, de Moor JS , et al. An action plan for translating cancer survivorship research into care. J Natl Cancer Inst 2014; 106(11):pii: dju287. doi: 10.1093/jnci/dju287. doi: 10.1093/jnci/dju287 pmid: 25249551
[26]	Ciemins EL, Blum L, Nunley M , et al. The economic and clinical impact of an inpatient palliative care consultation service: a multifaceted approach. J Palliat Med 2007; 10(6):1347-55. doi: 10.1089/jpm.2007.0065. doi: 10.1089/jpm.2007.0065 pmid: 18095814
[27]	Round J, Leurent B, Jones L . A cost-utility analysis of a rehabilitation service for people living with and beyond cancer. BMC Health Serv Res 2014; 14(1):558. doi: 10.1186/s12913-014-0558-5. doi: 10.1186/s12913-014-0558-5 pmid: 4245741
[28]	Smith SR, Reish AG, Andrews C . Cancer survivorship: a growing role for physiatric care. PM R 2015; 7(5):527-31. doi: 10.1016/j.pmrj.2014.12.004. doi: 10.1016/j.pmrj.2014.12.004 pmid: 25529615

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