Integration of oncology and palliative care: a Lancet Oncology Commission.

Détails

ID Serval
serval:BIB_CFA5D0934A1B
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Titre
Integration of oncology and palliative care: a Lancet Oncology Commission.
Périodique
The Lancet. Oncology
Auteur(s)
Kaasa S., Loge J.H., Aapro M., Albreht T., Anderson R., Bruera E., Brunelli C., Caraceni A., Cervantes A., Currow D.C., Deliens L., Fallon M., Gómez-Batiste X., Grotmol K.S., Hannon B., Haugen D.F., Higginson I.J., Hjermstad M.J., Hui D., Jordan K., Kurita G.P., Larkin P.J., Miccinesi G., Nauck F., Pribakovic R., Rodin G., Sjøgren P., Stone P., Zimmermann C., Lundeby T.
ISSN
1474-5488 (Electronic)
ISSN-L
1470-2045
Statut éditorial
Publié
Date de publication
11/2018
Peer-reviewed
Oui
Volume
19
Numéro
11
Pages
e588-e653
Langue
anglais
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Résumé
Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care.
Mots-clé
Attitude of Health Personnel, Attitude to Death, Cooperative Behavior, Critical Pathways/organization & administration, Delivery of Health Care, Integrated/organization & administration, Health Knowledge, Attitudes, Practice, Humans, Interdisciplinary Communication, Medical Oncology/organization & administration, Neoplasms/diagnosis, Neoplasms/mortality, Neoplasms/therapy, Palliative Care/organization & administration, Patient Care Team/organization & administration, Quality of Life, Treatment Outcome
Pubmed
Web of science
Création de la notice
05/11/2018 9:24
Dernière modification de la notice
20/08/2019 15:50
Données d'usage