美国缓和医疗和临终关怀开展的背景与展望

Development of palliative and hospice care in the United States: background and prospective

在过去的十年中,缓和医疗和临终关怀服务是美国医疗发展最迅速的专业领域。缓和医疗和临终关怀的益处已在多项临床研究中得到证实,患者及服务提供者对服务结果的满意度均有所提高。尽管如此,在美国扩大安宁缓和医疗及临终关怀服务仍然存在很多障碍和挑战,包括其他专科医师的抵制、患者及其家庭不切实际的期望、专业教育和从事缓和医疗临终关怀的人力资源的缺乏、社会意识、政策及财政报销等。缓和医疗的未来包括更多地渗透到其他专科的医疗服务中;在社区中,进一步识别最有效和最具成本效益的照护模式;建立更多的门诊服务和居家服务。对临终关怀服务的发展,探讨实施具有成本效益的、符合伦理的、文化上可接受的临终关怀服务所必需的变化类型及程度,是所有医疗专业人员的重要职责。

In the past decade, palliative care and End of Life Care-（EOLC） services have been the most rapidly growing fields of health care in the United States. The benefits of palliative care and EOLC have now been shown in multiple clinical studies, with increased patient and provider satisfaction. Nevertheless, there are still many barriers and challenges in the United States to expand use of services include physician resistance, unrealistic expectations of patients and families, lack of the educations and workforce, society awareness, government policy and financial reimbursement. The future ofpaUiative care includes more penetration into other medical specialties; further discernment of the most effective and cost-effective models to community＇s settings; and establishment of more outpatient services and home care services. As for the EOLC, it is a critical responsibility of all health care professionals in discussing the type and magnitude of changes necessary to implement cost- effective, ethically considerate, culturally acceptable changes in EOLC services.