缓和医疗医师资质认证对医生的能力提出了基本的要求,在规范缓和医疗临床实践和学科发展中具有重要的意义。缓和医疗水平较高的国家和地区多已确立官方资质认证体系,但也逐渐展现出培训与认证时间周期长、专科医师缺乏等问题。本文分析比较部分国家和地区缓和医疗医师资质认证的报考条件、内容和标准3方面的共性与差异,并综述缓和医疗医师资质认证所面对的问题,以期为我国缓和医疗的发展带来参考与启示。
Palliative care physician certification puts forward the basic competences of physicians, which is of great significance in standardizing palliative clinical practice and discipline development. Most countries with higher level of palliative care discipline have established official certification system, but the challenges from long term training cycle and lack of palliative care specialists, which have brought shortage of palliative care specialists. This paper presents the similarities and differences in palliative care certification from some countries and regions and reviews the barriers that must overcome to establish certification system, in order to bring enlightenment for the development of palliative care in China.
[1] World Health Organization. Palliative Care[EB/OL].(2020-08-05)[2021-05-11]. https://www.who.int/news-room/fact-sheets/detail/palliative-care.
[2] Hughes MT, Smith TJ. The growth of palliative care in the United States[J].Annu Rev Public Health, 2014,35:459-475. DOI: 10.1146/annurev-publhealth-032013-182406.
[3] 宁晓红. 中国大陆应该大力发展安宁缓和医疗事业——北京协和医院的经验体会[J].中国医学伦理学,2019,32(3):293-298,318. DOI: 10.12026/j.issn.1001-8565.2019.03.03.
[4] 宁晓红. 中国缓和医疗的发展和思考[J].中国医学科学院学报,2019,41(5):723-725.
[5] Centeno C, Bolognesi D, Biasco G. Comparative analysis of specialization in palliative medicine processes within the World Health Organization European region[J]. J Pain Symptom Manage, 2015,49(5):861-870. DOI: 10.1016/j.jpainsymman.2014.10.019.
[6] Centeno C, Noguera A, Lynch T, et al. Official certification of doctors working in palliative medicine in Europe: data from an EAPC study in 52 European countries[J]. Palliat Med, 2007,21(8):683-687. DOI: 10.1177/0269216307083600.
[7] Nora LM, McGreal SF, Nugent SG. Board certification: going back to the future[J]. Ophthalmology, 2016,123(9 Suppl):S55-S60. DOI: 10.1016/j.ophtha.2016.06.016.
[8] Downar J. Resources for educating, training, and mentoring all physicians providing palliative care[J]. J Palliat Med, 2018,21(S1):S57-S62. DOI: 10.1089/jpm.2017.0396.
[9] Yamaguchi T, Kuriya M, Morita T, et al. Palliative care development in the Asia-Pacific region: an international survey from the Asia Pacific Hospice Palliative Care Network (APHN)[J]. BMJ Support Palliat Care, 2017,7(1):23-31. DOI: 10.1136/bmjspcare-2013-000588.
[10] 汪存友. 科学设定职业资格考试合格标准[J].中国考试,2012(4):43-47.
[11] Lupu D. Estimate of current hospice and palliative medicine physician workforce shortage[J]. J Pain Symptom Manage, 2010,40(6):899-911. DOI: 10.1016/j.jpainsymman.2010.07.004.
[12] Quill TE, Abernethy AP. Generalist plus specialist palliative care--creating a more sustainable model[J]. N Engl J Med, 2013,368(13):1173-1175. DOI: 10.1056/NEJMp1215620.
[13] Brown CR, Hsu AT, Kendall C, et al. How are physicians delivering palliative care? a population-based retrospective cohort study describing the mix of generalist and specialist palliative care models in the last year of life[J]. Palliat Med, 2018,32(8):1334-1343. DOI: 10.1177/0269216318780223.
[14] von Gunten CF. Secondary and tertiary palliative care in US hospitals[J]. JAMA, 2002,287(7):875-881. DOI: 10.1001/jama.287.7.875.
[15] Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer[J]. N Engl J Med, 2010,363(8):733-742. DOI: 10.1056/NEJMoa1000678.
[16] Carroll T, El-Sourady M, Karlekar M, et al. Primary palliative care education programs: review and characterization[J]. Am J Hosp Palliat Care, 2019,36(6):546-549. DOI: 10.1177/1049909118809947.
[17] Bergenholtz H, Hølge-Hazelton B, Jarlbaek L. Organization and evaluation of generalist palliative care in a Danish hospital[J]. BMC Palliat Care, 2015,14:23-23. DOI: 10.1186/s12904-015-0022-2.
[18] Kang J, Kim Y, Yoo YS, et al. Developing competencies for multidisciplinary hospice and palliative care professionals in Korea[J]. Support Care Cancer, 2013,21(10):2707-2717. DOI: 10.1007/s00520-013-1850-3.
[19] Paal P, Brandstötter C, Lorenzl S, et al. Postgraduate palliative care education for all healthcare providers in Europe: Results from an EAPC survey[J]. Palliat Support Care, 2019,17(5):495-506. DOI: 10.1017/S1478951518000986.
[20] 宋爽, 宁晓红. 国外面向医学生的舒缓医学教育发展及启示[J].中国医学科学院学报,2018,40(3):385-399. DOI: 10.3881/j.issn.1000-503X.2018.03.015.
[21] 张杰, 彭琰, 王治仁, 等. 中日两国医学院校医学专业老年临终关怀教育的比较[J]. 中国老年学杂志,2010,30(6):818-820. DOI: 10.3969/j.issn.1005-9202.2010.06.039.
[22] 宁晓红, 董祈, 曲璇, 等. 高年资内科医师对安宁缓和医疗的认知及需求[J].中国临床保健杂志,2020,23(3):321-324. DOI: 10.3969/J.issn.1672-6790.2020.03.009.
[23] 王雨婷, 董碧蓉. 缓和医学概述[J].现代临床医学,2016,42(2):157-60. DOI: 10.11851/j.issn.1673-1557.2016.02.026.
