Abstract：
BACKGROUND: Non-beneficial treatment is closely tied to inappropriate treatment at the end-of-life. Understanding the interplay between how and why these situations arise in acute care settings according to the various stakeholders is pivotal to informing decision-making and best practice at end-of-life.
OBJECTIVE: To define and understand determinants of non-beneficial and inappropriate treatments for patients with a non-cancer diagnosis, in acute care settings at the end-of-life.
METHODS: Systematic review of peer-reviewed studies focusing on the above and conducted in upper-middle- and high-income countries. A narrative synthesis was undertaken, guided by Realist principles.
METHODS: Cochrane; PubMed; Scopus; Embase; CINAHL; and Web of Science.
RESULTS: Sixty-six studies (32 qualitative, 28 quantitative, and 6 mixed-methods) were included after screening 4,754 papers. Non-beneficial treatment was largely defined as when the burden of treatment outweighs any benefit to the patient. Inappropriate treatment at the end-of-life was similar to this, but additionally accounted for patient and family preferences. Contexts in which outcomes related to non-beneficial treatment and/or inappropriate treatment occurred were described as veiled by uncertainty, driven by organizational culture, and limited by profiles and characteristics of involved stakeholders. Mechanisms relating to \'Motivation to Address Conflict & Seek Agreement\' helped to lessen uncertainty around decision-making. Establishing agreement was reliant on \'Valuing Clear Communication and Sharing of Information\'. Reaching consensus was dependent on \'Choices around Timing & Documenting of end-of-life Decisions\'.
CONCLUSIONS: A framework mapping determinants of non-beneficial and inappropriate end-of-life treatment is developed and proposed to be potentially transferable to diverse contexts. Future studies should test and update the framework as an implementation tool.
BACKGROUND: PROSPERO Protocol CRD42021214137 .
OBJECTIVE: To define and understand determinants of non-beneficial and inappropriate treatments for patients with a non-cancer diagnosis, in acute care settings at the end-of-life.
METHODS: Systematic review of peer-reviewed studies focusing on the above and conducted in upper-middle- and high-income countries. A narrative synthesis was undertaken, guided by Realist principles.
METHODS: Cochrane; PubMed; Scopus; Embase; CINAHL; and Web of Science.
RESULTS: Sixty-six studies (32 qualitative, 28 quantitative, and 6 mixed-methods) were included after screening 4,754 papers. Non-beneficial treatment was largely defined as when the burden of treatment outweighs any benefit to the patient. Inappropriate treatment at the end-of-life was similar to this, but additionally accounted for patient and family preferences. Contexts in which outcomes related to non-beneficial treatment and/or inappropriate treatment occurred were described as veiled by uncertainty, driven by organizational culture, and limited by profiles and characteristics of involved stakeholders. Mechanisms relating to \'Motivation to Address Conflict & Seek Agreement\' helped to lessen uncertainty around decision-making. Establishing agreement was reliant on \'Valuing Clear Communication and Sharing of Information\'. Reaching consensus was dependent on \'Choices around Timing & Documenting of end-of-life Decisions\'.
CONCLUSIONS: A framework mapping determinants of non-beneficial and inappropriate end-of-life treatment is developed and proposed to be potentially transferable to diverse contexts. Future studies should test and update the framework as an implementation tool.
BACKGROUND: PROSPERO Protocol CRD42021214137 .
摘要：
背景：非有益治疗与临终时的不适当治疗密切相关。根据各种利益相关者，了解急性护理环境中这些情况的发生方式和原因之间的相互作用对于告知生命末期的决策和最佳实践至关重要。
目的：定义和理解非癌症诊断患者的非有益和不适当治疗的决定因素，在临终的急性护理环境中。
方法：针对以上内容的同行评审研究的系统评价，并在中高收入国家进行。进行了叙事综合，以现实主义原则为指导。
方法：Cochrane；PubMed；Scopus；Embase；CINAHL；和WebofScience。
结果：66项研究(32项定性，28定量，和6种混合方法)在筛选4,754篇论文后纳入。非有益治疗在很大程度上被定义为当治疗负担超过对患者的任何益处时。临终时的不当治疗与此相似，但也考虑了患者和家庭的偏好。与非有益治疗和/或不适当治疗相关的结果的上下文被描述为由不确定性掩盖。在组织文化的推动下，并受到相关利益相关者的概况和特征的限制。与“解决冲突和寻求协议的动机”有关的机制有助于减少决策的不确定性。建立协议依赖于“重视清晰的沟通和信息共享”。达成共识取决于“围绕生命终结决策的时机和记录的选择”。
结论：开发了非有益和不适当的临终治疗的框架映射决定因素，并提出了可能转移到不同的环境。未来的研究应该测试和更新框架作为一个实施工具。
背景：PROSPERO协议CRD42021214137。
目的：定义和理解非癌症诊断患者的非有益和不适当治疗的决定因素，在临终的急性护理环境中。
方法：针对以上内容的同行评审研究的系统评价，并在中高收入国家进行。进行了叙事综合，以现实主义原则为指导。
方法：Cochrane；PubMed；Scopus；Embase；CINAHL；和WebofScience。
结果：66项研究(32项定性，28定量，和6种混合方法)在筛选4,754篇论文后纳入。非有益治疗在很大程度上被定义为当治疗负担超过对患者的任何益处时。临终时的不当治疗与此相似，但也考虑了患者和家庭的偏好。与非有益治疗和/或不适当治疗相关的结果的上下文被描述为由不确定性掩盖。在组织文化的推动下，并受到相关利益相关者的概况和特征的限制。与“解决冲突和寻求协议的动机”有关的机制有助于减少决策的不确定性。建立协议依赖于“重视清晰的沟通和信息共享”。达成共识取决于“围绕生命终结决策的时机和记录的选择”。
结论：开发了非有益和不适当的临终治疗的框架映射决定因素，并提出了可能转移到不同的环境。未来的研究应该测试和更新框架作为一个实施工具。
背景：PROSPERO协议CRD42021214137。
