意大利成人3/4级胶质瘤患者姑息治疗指南。
完整摘要 · 中文译文
背景：成人胶质瘤患者的姑息与支持治疗需求较为复杂。2017年，欧洲神经肿瘤学会（EANO）针对该人群的姑息治疗（PC）发布了指南。 目的：通过更新EANO指南并使其适应意大利国情，制定一部针对中枢神经系统（CNS）WHO 3/4级胶质瘤成人患者姑息治疗的临床实践指南。 方法：该指南由意大利神经病学、神经肿瘤学和姑息治疗三大主要科学协会任命的跨学科、包含患者代表的小组制定，遵循推荐分级的评估、制定与评价（GRADE）方法。 结果：小组提出了两个临床问题，由三条推荐意见（均基于极低确定性证据）和一项良好实践声明予以回答：（1）我们建议使用结构化沟通干预措施来传达诊断、预后和/或治疗及照护选择（有条件推荐）。（2）我们推荐使用相关方法/工具以促进决策能力下降的成人胶质瘤患者的信息处理（强推荐）。（3）我们认为适宜监测沟通可能带来的情绪影响，并为成人胶质瘤患者及其照护者提供支持（良好实践声明）。（4）我们建议为CNS WHO 3/4级胶质瘤成人患者提供一种医疗照护模式，通过对新出现的健康需求进行早期、动态、跨学科和多专业的管理，将最佳抗肿瘤治疗与姑息治疗相结合。该整合模式 应与患者的照护偏好和照护者的需求保持一致，并在整个疾病轨迹和所有照护环境中提供（有条件推荐）。 结论：本指南为改善成人胶质瘤患者及其照护者的沟通和整合性姑息治疗（PC）提供了推荐意见。本指南还指出了该人群未来研究优先方向的提示。
完整摘要 · 英文原文
BACKGROUND: The palliative and supportive care needs of adults with glioma are complex. In 2017, the European Association for Neuro-Oncology (EANO) published the guideline on palliative care (PC) in this population. OBJECTIVE: To develop a clinical practice guideline for the PC of adults with CNS WHO grade 3/4 gliomas by updating and adapting the EANO guideline to the Italian context. METHODS: The guideline was produced by an interdisciplinary, consumer-inclusive panel appointed by the three main Italian scientific associations for neurology, neuro-oncology and PC, following the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: The panel formulated two clinical questions, addressed by three recommendations (all based on very-low-certainty evidence) and one Good Practice Statement: (1) We suggest the use of structured communication interventions to convey diagnosis, prognosis, and/or therapeutic and care options (conditional recommendation). (2) We recommend using approaches/tools to facilitate information processing in adults with glioma with reduced decision-making capacity (strong recommendation). (3) We believe it is appropriate to monitor the emotional impact that communication can have, and to provide support to adults with glioma and their caregivers (Good Practice Statement). (4) We suggest offering adults with CNS WHO grade 3/4 glioma a healthcare model that integrates the best anti-tumor and palliative treatments through early, dynamic, interdisciplinary, and multi-professional management of emerging health needs. The integrated model should be aligned with patients' care preferences and caregivers' needs and provided throughout the whole disease trajectory and across all care settings (conditional recommendation). CONCLUSIONS: This guideline provides recommendations for improving communication and integrated PC for adults with glioma and their caregivers. It also provides indications for future research priorities in this population.