Mounting evidence supports oncology organizations' recommendations of early palliative care as a cancer care best practice for patients with advanced cancer and/or high symptom burden. However, few trials on which these best practices are based have included rural and remote community-based oncology care. Therefore, little is known about whether early palliative care models are applicable in these low-resource areas. This literature synthesis identifies some of the challenges of integrating palliative care in rural and remote cancer care. Prominent themes include being mindful of rural culture; adapting traditional geographically based specialty care delivery models to under-resourced rural practices; and using novel palliative care education delivery methods to increase community-based health professional, layperson, and family palliative expertise to account for limited local specialty palliative care resources. Although there are many limitations, many rural and remote communities also have strengths in their capacity to provide high-quality care by capitalizing on close-knit, committed community practitioners, especially if there are receptive local palliative and hospice care champions. Hence, adapting palliative care models, using culturally appropriate novel delivery methods, and providing remote education and support to existing community providers are promising advances to aid rural people to manage serious illness and to die in place. Reformulating health policy and nurturing academic-community partnerships that support best practices are critical components of providing early palliative care for everyone everywhere.

中文翻译：

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开拓新领域：为农村和偏远地区的癌症患者提供姑息治疗

越来越多的证据支持肿瘤学组织将早期姑息治疗作为晚期癌症和/或高症状负担患者的癌症护理最佳实践的建议。然而，这些最佳实践所依据的试验很少包括农村和偏远社区的肿瘤学护理。因此，人们对早期姑息治疗模式是否适用于这些资源匮乏地区知之甚少。该文献综合确定了在农村和偏远癌症护理中整合姑息治疗的一些挑战。突出的主题包括关注乡村文化；将传统的基于地理的专业护理提供模式适应资源不足的农村实践；并使用新颖的姑息治疗教育提供方法来增加以社区为基础的卫生专业人员、外行、和家庭姑息专业知识，以解决当地有限的专业姑息护理资源。尽管存在许多限制，但许多农村和偏远社区也有能力通过利用关系密切、忠诚的社区从业者来提供高质量的护理，尤其是在有乐于助人的当地姑息治疗和临终关怀支持者的情况下。因此，适应姑息治疗模式、使用适合文化的新型交付方法，以及为现有社区提供者提供远程教育和支持，都是帮助农村人民控制严重疾病和就地死亡的有希望的进步。重新制定卫生政策和培养支持最佳实践的学术社区伙伴关系是为世界各地的每个人提供早期姑息治疗的关键组成部分。