Plenary X - Palliative Care and End-of-life Care in the Community

本次演讲将探讨医疗共同决策(SDM)作为一种协作式医疗决策方法的发展与应用。我们追溯了SDM理论从初始框架到后续改进的演变过程，通过重要里程碑呈现国际SDM发展历程，包括国际患者决策辅助工具标准的建立，以及多国支持患者参与医疗决策的法律框架的采纳。在中国，尽管自1998年以来学术界对SDM的关注度不断提高，但其实施仍处于起步阶段，面临缺少政策与法律支持、文化因素及专业培训不足等独特挑战。中国医疗环境呈现出特殊考量，尤其是家庭在医疗决策中的参与，这需要对西方SDM模式进行文化适应性调整。最后本次演讲将分享北京协和医院缓和医学中心的共同决策实践经验，希望得到参会同仁的建议与意见，也给大家一些启发。
This presentation will explore the development and application of Shared Decision Making (SDM) as a collaborative approach to healthcare decisions. We will trace the evolution of SDM theory from its initial framework to subsequent improvements, presenting the international development of SDM through key milestones, including the establishment of International Patient Decision Aid Standards and the adoption of legal frameworks supporting patient participation in medical decisions across various countries. In China, despite increasing academic interest in SDM since 1998, its implementation remains in early stages, facing unique challenges including lack of policy and legal support, cultural factors, and insufficient professional training. Chinese healthcare settings present distinctive considerations, especially regarding family involvement in medical decisions, which requires culturally-appropriate adaptations of Western SDM models. Finally, this presentation will share practical experiences of shared decision making from Beijing Union Medical College Hospital's Palliative Medicine Center, hoping to receive suggestions and opinions from colleagues at this meeting, as well as provide inspiration for everyone.

Many great leaders have acknowledged the value of looking back in history in order to better understand the opportunities of the present, and to plan a strong future. 
This talk attempts the same, looking back on some of the history of hospice and palliative care in order to assist participants identify priorities for the future of this important area of care. There are strong arguments to support ongoing investment in advancing and improving palliative and end of life care, but the questions of where to focus effort and how often remain unclear. 


To answer those questions, this session will consider the work of St Christopher's Hospice in the UK over the last half decade, with particular attention to the nature and models of care it has provided and their impact. It will consider the relationship of the hospice with wider systems of palliative, health and social care, including hospitals, and the benefits and challenges of integration. Attention will also be given to its different strategic priorities and leadership styles over the years and the degree to which these have influenced progress. The year 2025 marks 20 years since Dame Cicely Saunders, founder of St Christopher's and the modern hospice movement died, and so some attention will be drawn to her work and legacy, as guidance regarding future direction and effort. 


This talk is not designed to position the work of St Christopher's as a blueprint for the future of palliative care. Infact, the case will be made for quite the opposite. The experiences of life, death, loss and caring in the UK are arguably poor currently for many people, and much work is required to increase the value of death in the ways we live, our policies, professional practices and organisational priorities. This talk invites new conversations and shared learning across countries and systems to improve how people live, die and grieve in our organisations and societies in the future.