The Future of Palliative Care姑息关怀的未来

玛格丽特·迪雷恩　唐昉/译

Medical advancements are occurring in artificial intelligence （AI） and information and communications technology （ICT） and in the fields of biotechnology and precision medicine， which can tailor medications and ther-apies to the unique biological makeup of the individual. These developments are revolutionising health care now and will continue to do so into the future.

医学进步渐渐在人工智能、信息通信技术以及生物技术和精准医疗领域显现，其成果在于可以根据个体独特的生理结构定制药物和疗法。目前，这些发展成果正在彻底改变医疗保健领域，而且未来还会持续引发行业变革。

Palliative care is not immune from these changes and clinicians working in palliative care will find themselves working with new technologies and data sources to inform their practice and care of palliative patients.

姑息关怀也难免受到这些变化的影响。姑息关怀科的临床医生势必会使用新技术、利用新数据源，指导自己的医疗行为和对患者的姑息关怀。

Looking forward to the next 10 or so years， patients and consumers will have access to a range of data that has not previously been available to them. Health professionals will increasingly need to adapt their service models to include the patient as a key resource in health decision making， acknowledging that patients will have more information about their own health at their fingertips. Smart technology will be used to monitor a persons health and well-being. Smart technology will routinely measure heart rate， blood pressure， breathing， weight， activity levels and could potentially predict when people are at risk of stroke， heart attack or other diseases and conditions.

展望未来十年左右的时间，患者和消费者将能获取一系列他们以前无法获取的数据。医技人员将越来越需要调整自身服务模式，让患者成为医疗决策的关键参与者，认识到患者将掌握更多关于自身健康的信息。智能技术将用于监测个人的身心健康——定期测量心率、血压、呼吸、体重、活动水平，并有可能预测人们何时会面临中风、心脏病发作或其他疾病和健康问题的风险。

Access to remote monitoring of health data will increase and this will mean that where individuals want this option， their data collected through smart technology will also be available to their health care teams. Clinicians can then be alerted earlier to a change in diagnosis or a need to change treatment options.

遠程监控健康数据的机会将会增加，这意味着如果人们需要这种服务，那么智能技术收集的个人健康数据也将提供给他们的医疗保健团队。如此一来，临床医生可以更早地收到提示信息，知晓病情诊断的变化或治疗方案的变更需求。

Not only will there be more data at the individual level， data collected at the macro level will also have implications for diagnosis and treatment options. Big data and artificial intelligence will have a greater role to play in medical forecasting and treatment.

不仅会有更多的个人数据，收集到的宏观数据也会对诊断和治疗方案产生影响。大数据和人工智能将在医学预测和治疗方面发挥更大的作用。

What can this mean in practice？ According to the Australian Council of Learned Academies （ACOLA） there will be “increasing ability to collect and codify clinical and laboratory data in aggregate through the use of big data tools—including supercomputing capacity， cloud storage and automated biometric， diagnostic and therapeutic data collection—allowing association of genomic and related information with biomarkers， diagnosis and clinical outcome.” This will enable patients to have a real-time medical condition assessment， which will lead to point-of-care interventions and predictive analytics for clinical decision-making. Based on this information， health and support services can be more preparative and responsive and less reactive.

这对医疗行为意味着什么呢？澳大利亚学术研究院委员会表示，“通过使用大数据手段（包括超级计算能力、云存储，以及自动收集生物特征信息、诊断和治疗数据），收集和整理所有临床与实验室数据的能力将不断提高，从而使基因组数据以及与之相关的信息得以和生物标志物、诊断、临床结局联系起来。”这将使患者能够实时接受病情评估，进而能为患者提供即时干预，为临床决策提供预测分析。基于上述信息，医疗和配套服务更能未雨绸缪，更能积极主动地作出响应，而非被动应对。

In a similar vein1， the computing power of artificial intelligence will assist scientists and pharmaceutical clinicians develop new and responsive medications that are directly related to a persons biological system and specific disease symptoms.

同样，人工智能的计算能力将帮助科学家和临床药师研发与人体生理系统和特定疾病症状直接相关的新型特效药。

This is the area where clinicians will see the biggest change—the tailoring of treatments to meet the biological make-up of their patients. The emerging field of biotechnology and precision medicine will mean that life-limiting illness is easier to predict and biological markers will provide a clearer indication of life expectancy for many people with varying diagnoses. As noted by the ACOLA， precision medicine is “the ability to ana-lyse disease in terms of an individuals make-up， when compared with and studied alongside aggregated clinical and laboratory data from healthy and diseased populations. Although medicine has always had personal and predictive aspects， precision medicine allows health and disease to be viewed at an increasingly fine-grained resolution， attuned2 to the complexities of both the biology of each individual and vari-ation within the population.” In other words， there will be an increasing move away from a one size fits all approach for disease treatment and prevention to very tailored individual treatment and prevention plans.

这是临床医生将见证最大变化的领域——量身定制治疗方案以适应患者的生理特性。生物技术与精准医疗领域的兴起将意味着绝症更容易预测，生物标志物将为众多患有不同疾病的人提供更明确的预期寿命指标。正如澳大利亚学术研究院委员会所指出的，精准医疗指“能够通过对健康人群和患病人群的临床与实验室汇总数据进行比较和研究，根据个体的具体情况分析疾病。虽然医学总是涉及个体差异和预测因素，但精准医疗能越来越精细地解析健康和疾病，适应每个个体生物学特征的复杂性和群体内个体差异的复杂性”。换句话说，疾病的治疗与预防将渐渐从“一刀切”的方法，转向量身定制的个体治疗与预防方案。

This will mean that the treatment of life-limiting illnesses such as cancer or neurodegenerative3 diseases will be managed using knowledge about an individuals biological system to increase the efficacy of treatment outcomes. This will include immunotherapy4， which enables a person to use their own immune system to fight off a disease. This could reduce the need for radiotherapy5， chemo-therapy or surgery. If a person does need chemotherapy， the emerging field of nanotechnology will increasingly be used to target cancer cells without the current side effects.

這意味着针对癌症或神经系统变性疾病等绝症的治疗，将基于有关个体生理系统的信息，以此提高治疗效果。治疗方法将包括免疫疗法，即让病人能够利用自身免疫系统对抗疾病，可减少对放疗、化疗或手术的需求。如果病人确实需要化疗，新兴的纳米技术将越来越多地用于靶向癌细胞，而不会产生现有的副作用。

So what does this all mean for palliative care clinicians？

那么，这对姑息关怀科的临床医生意味着什么呢？

Emerging treatment and interventions using advanced biotechnological options and incorporating the benefits of big data and artificial intelligence will mean that many people will be kept alive for longer and where they need ser-ious treatment， the side effects should be less physically diminishing than in the past and currently.

新興的治疗和干预方法运用先进的生物技术，结合了大数据和人工智能的优势。这意味着许多患者将活得更久，即使他们需要高强度治疗，副作用对身体的损害也会比过去和现在更小。

So while all these advances are generally positive， the fact remains that people will still have life-limiting illness and will need help living with the symptoms of their illness while also preparing for their death. It is also known that the dominant illnesses accounting for growth in palliative care need will be dementia and cancer. According to the CSIRO6， there will be an increase in neurodegenerative disorders， and a changing spectrum of cancers as the common cancers become more survivable… the associated increasing lifespans will see more individuals develop rare and less common cancers such as pancreatic7 and renal8.

因此，尽管上述医学发展成果大体是积极的，现实却与以往无异——人们仍然会身患绝症，依旧需要有人帮他们在带病生存的同时做好死亡的准备。众所周知，导致姑息关怀需求增长的主要疾病将是失智症和癌症。根据澳大利亚联邦科学与工业研究组织的说法，神经系统变性疾病的病例将会增加，而且随着常见癌症的生存率提高，癌症谱系将不断变化……随之而来的寿命延长可能会让更多人患上罕见和不常见的癌症，比如胰腺癌和肾癌。

Comorbidity9 will be significant factor in palliative care. Many people will live with more than one comorbid condition. “This means that the complexity of palliative care need is likely to grow due to the high symptom burden， complex healthcare needs and high hospitalisation rates of patients with multimorbidity.”

共病将是姑息关怀的重要因素。许多病人可能患有不止一种共存性疾病。“这意味着由于多重疾病患者的症状负担大、医疗需求复杂、住院率高，姑息关怀需求的复杂性可能会加剧。”

To manage all of these factors will require a sophisticated array of skills. Consumers will expect their health practitioners to be able to work with the latest technological advancements and incorporate biotechnology and precision medicine into care and treatment options and to minimise negative side-effects. Specifically for palliative care， patients and their carers will depend on the skills， knowledge and experience of palliative care clinicians in interpreting the data and assessing the multitude of treatment options to determine the best care path available.

要想控制好上述因素，需要一系列复杂巧妙的技能。消费者期望医疗从业者能够利用技术发展的最新成果，将生物技术和精准医疗融入护理和治疗方案，并最大限度地减少不良反应。具体到姑息关怀，患者及其照护者将依赖姑息关怀科临床医生根据自己的专业技能、知识和经验来解读数据，并评估多种治疗选择，最终确定可行的最佳疗护方案。

In addition to the changes that emerging medical advances and technologies will have for the care options available to people with life-limiting illness， palliative care clinicians will increasingly be called on to advise patients about when enough is enough for treatment proposed by other medical clinicians. The growing accessibility of biotechnology options will run the risk of more people being on a treatment treadmill and there will always be a point where further treatment will be too burdensome or non-beneficial. Palliative care expertise will be needed more than ever to advise patients about when to stop more active treatments and interventions and to ensure patients have quality of life and avoid unnecessary pain and distress.

逐漸显现的医学进步和新兴技术将为患有绝症的病人带来疗护方案的变化。除此之外，越来越多的病人将要求姑息关怀科的临床医生给出建议，告诉他们其他科室临床医生提出的治疗何时该停。生物技术的日益普及可能会使更多病人处于持续治疗的状态，而治疗终有一天会变得徒劳无功。未来将比以往任何时候都更需要姑息关怀专家向患者提供建议——何时停止积极治疗和干预，如何确保生活质量，怎样避免不必要的疼痛和苦恼。

It is important that palliative care remains a human service within the context of this changing world. Technology needs to be balanced with the counterforce of human contact and kindness together with the expertise to advise and guide people about what is best for them. In addition to the high quality medical care and treatment provided by palliative care clinicians， palliative care will continue to provide high quality psychosocial， emotional and spiritual care for the person receiving palliative care along with grief and bereavement10 support for family and loved ones.

重要的是，在这个不断变化的世界中，姑息关怀仍然是一项人性化服务。运用技术的同时要兼顾与之相抵的人际交往和怀善之心，还要搭配专业知识，以建议和指导病人怎么做才是最适合他们的。除了姑息关怀科临床医生提供的高质量护理和治疗外，姑息关怀还将持续为接受这项服务的病人提供高质量的社会心理、情感和精神关怀，并为其亲属提供悲痛安抚和丧亲支持服务。

We are entering a new age where some things will change dramatically but the core essence of what palliative care offers now will be needed more than ever into the future.

我们渐渐迈入一个新时代，有些事情将会发生巨大变化，但未来将比以往任何时候都更需要姑息关怀所呈现出的核心本质。

（译者为“《英语世界》杯”翻译大赛获奖者）