緩和ケアと医学

抽象的な

Meeting the Global Abyss: A Framework for Local Patient-Centered Palliative Care

Richard R Love and Sheikh I Ahamed

The majority of global deaths are characterized by misery and limited palliation and occur in low- and middleincome countries (LMICs). Strategies for addressing the growing challenges of end-of-life palliative care, particularly those concerned with physical aspects of care, have been defined based on high-income country models of health care services and research. In LMICs, access to adequate quality primary care practitioners and oncologists is limited, and calls for training these specialists and palliative care physician specialists, even if heeded, cannot be expected to meet the growing palliative care population needs.

An applicable general framework for addressing this patient-centred abyss however, is now apparent, grounded in emerging favourable data about three components: new kinds of health paraprofessionals; information technology (IT) tools; and innovative health system approaches.

Routinizing palliative care can allow development of paraprofessional palliative care specialists. IT tools of importance include cell phone-based symptom questionnaires; internet facilitated virtual caregiver-patient visits and sharing of personal patient and family educational materials, and automated decision-making algorithms for symptom management. Health system approaches with these foregoing operational efficiencies and improved productivity can allow more and higher-quality care for more patients in need.

New local approaches are needed to address the right questions about public health palliative care.