PDF(Sci-hub)
Abstract：
Objectives: This study was conducted before an evidence review on Traditional and Complementary Medicine (TCM) to update the clinical practice guidelines (CPGs): \"Deciding palliative and end-of-life (P/EoL) care for people with diabetes.\" The aim was to frame the PICO (population/problems, interventions/comparisons, and outcomes), ascertain their importance, and identify other modifying factors for grading recommendations. Design: A systematic scoping review mapped information about diabetes P/EoL problems and outcomes, TCM use, provision, benefits and risks, and stakeholder preferences and values. Thirteen electronic databases were searched in 2017/18 until no new information was identified. Relevant data were extracted, rated for quality, directness, and relevance, and synthesized using triangulation methods. Excluded was diabetes prevention or treatment, as this is not an important P/EoL problem. Results: Of the 228 included articles, except for diabetes P/EoL problems, insufficient direct evidence led to data being extrapolated from either adults with diabetes or any P/EoL diagnosis. The findings affirmed that caring for people with diabetes in need of P/EoL care is complex due to multiple fluctuating needs that are influenced by the P/EoL trajectories (stable, unstable, deteriorating, terminal, or bereaved), multimorbidity, and difficult-to-manage chronic and acute problems. The only problem specific to diabetes P/EoL care, was unstable glycemia. Over 50 TCM interventions commonly used by patients and/or provided by services were identified, of which, many might simultaneously address multiple problems and 18 had been appraised in systematic reviews. Physical and psychologic symptom reliefs were most often evaluated; however, these were only one aspect of a \"good death.\" Other important outcomes were the quality and location of care, personal agency, relationships, preparations for the dying process, spirituality, and affirmation of the whole person. Other important modifying factors included opportunity costs, affordability, availability, preferences, cultural appropriateness, and alignment with beliefs about the meaning of illness and death. Conclusions: There is a role for TCM in the multidisciplinary holistic P/EoL care of people with diabetes. Due to the paucity of evidence specific to this population, the generalizability of some of these results is broader and the updated CPG will also need to consider indirect evidence from other patient groups. Along with recommendations about indications for TCM use, the CGP should provide guidance on ceasing unnecessary interventions, reducing polypharmacy and managing unstable glycemia is required. Before ceasing a TCM, a broader risk-benefit analysis is recommended, as unlike many conventional therapies, there may be multiple benefits warranting its continuation.
摘要：
目标：这项研究是在对传统和补充医学（TCM）进行证据审查之前进行的，以更新临床实践指南（CPG）：“决定对糖尿病患者的姑息治疗和临终治疗（P/EoL）。\“目的是构建PICO(人口/问题，干预/比较，和结果)，确定其重要性,并确定评分建议的其他修改因素。设计：系统的范围审查映射有关糖尿病P/EoL问题和结果的信息，中药使用，provision,收益和风险，以及利益相关者的偏好和价值观。在2017/18年度搜索了13个电子数据库，直到没有发现新的信息。提取相关数据,评定质量，直接性，和相关性，并使用三角测量方法合成。不包括糖尿病的预防或治疗，因为这不是一个重要的P/EoL问题。结果：在228篇文章中，除了糖尿病P/EOL问题，不充分的直接证据导致数据从成人糖尿病患者或任何P/EoL诊断推断.研究结果证实，由于受P/EoL轨迹影响的多种波动需求，对需要P/EoL护理的糖尿病患者的护理是复杂的（稳定，不稳定,恶化，终端,或丧亲)，多浊度,以及难以管理的慢性和急性问题。糖尿病P/EoL护理特有的唯一问题，是不稳定的血糖。确定了50多种患者常用和/或服务提供的中医干预措施，其中，许多可能同时解决多个问题，并在系统审查中评估了18个。最常评估身体和心理症状缓解；然而，这些只是“好死”的一个方面。“其他重要的结果是护理的质量和位置，个人机构,关系,为染色过程做准备，灵性,对整个人的肯定。其他重要的修改因素包括机会成本，负担能力，可用性,preferences,文化适宜性，与关于疾病和死亡含义的信念保持一致。结论：中医在糖尿病患者的多学科整体P/EoL护理中具有重要作用。由于缺乏特定于该人群的证据，其中一些结果的概括性更广,更新的CPG还需要考虑其他患者组的间接证据.除了有关中医使用适应症的建议外，CGP应该就停止不必要的干预提供指导，需要减少多重用药和管理不稳定的血糖。在停止中医之前，建议进行更广泛的风险收益分析，与许多传统疗法不同，可能有多种好处可以保证它的延续。
