PDF(Pubmed)
Abstract：
BACKGROUND: Although surgery is the gold standard following a hip fracture, the potential for rehabilitation and survival rates are low in frail older patients. Some patients may derive more benefit from palliative care. The objectives of this review were to identify the available strategies to improve end-of-life decision-making and palliative care for frail patients with hip fractures and to synthetise their level of support.
METHODS: We conducted a scoping review of the scientific and grey literature, searching seven databases and websites of associations. We included all study designs, expert opinion articles and clinical practice guidelines (CPGs). Data were synthetised according to the Approach to Patient with Limited Life Expectancy and Hip Fracture framework. The number of research items and their level of evidence were tabulated for each of the recommended strategies.
RESULTS: Of the 10 591 items identified, 34 were eligible. The majority of included articles were original research studies (n = 15). Half of the articles and CPGs focused on intervention categories (55%) such as goals of care discussion and comfort care, followed by factors to consider in the end-of-life decision-making process (25%) and prognosis assessments (20%), mainly through the estimation of life expectancy. The level of evidence for these strategies remains low, given the limited number of prospective studies supporting them.
CONCLUSIONS: This scoping review highlighted that end-of-life care in frail older patients with a hip fracture remains understudied. The strategies identified could be prioritised for future research to improve the well-being of the target population while promoting sustainable resource management.
METHODS: We conducted a scoping review of the scientific and grey literature, searching seven databases and websites of associations. We included all study designs, expert opinion articles and clinical practice guidelines (CPGs). Data were synthetised according to the Approach to Patient with Limited Life Expectancy and Hip Fracture framework. The number of research items and their level of evidence were tabulated for each of the recommended strategies.
RESULTS: Of the 10 591 items identified, 34 were eligible. The majority of included articles were original research studies (n = 15). Half of the articles and CPGs focused on intervention categories (55%) such as goals of care discussion and comfort care, followed by factors to consider in the end-of-life decision-making process (25%) and prognosis assessments (20%), mainly through the estimation of life expectancy. The level of evidence for these strategies remains low, given the limited number of prospective studies supporting them.
CONCLUSIONS: This scoping review highlighted that end-of-life care in frail older patients with a hip fracture remains understudied. The strategies identified could be prioritised for future research to improve the well-being of the target population while promoting sustainable resource management.
摘要：
背景：虽然手术是髋部骨折后的黄金标准，虚弱的老年患者的康复潜力和生存率很低。一些患者可能从姑息治疗中获得更多益处。本综述的目的是确定可用的策略，以改善脆弱的髋部骨折患者的临终决策和姑息治疗，并综合其支持水平。
方法：我们对科学和灰色文献进行了范围审查，搜索七个数据库和协会网站。我们包括了所有的研究设计，专家意见文章和临床实践指南(CPGs)。根据预期寿命有限和髋部骨折框架患者的方法合成数据。列出了每个推荐策略的研究项目数量及其证据水平。
结果：在确定的10.591个项目中，34人符合条件。纳入的大多数文章都是原创性研究(n=15)。一半的文章和CPG关注干预类别(55%)，如护理讨论目标和舒适护理，其次是临终决策过程中需要考虑的因素（25%）和预后评估（20%），主要通过对预期寿命的估计。这些策略的证据水平仍然很低，鉴于支持他们的前瞻性研究数量有限。
结论：这项范围综述强调，对虚弱的老年髋部骨折患者的临终关怀仍未得到充分研究。确定的战略可以优先用于未来的研究，以改善目标人口的福祉，同时促进可持续的资源管理。
方法：我们对科学和灰色文献进行了范围审查，搜索七个数据库和协会网站。我们包括了所有的研究设计，专家意见文章和临床实践指南(CPGs)。根据预期寿命有限和髋部骨折框架患者的方法合成数据。列出了每个推荐策略的研究项目数量及其证据水平。
结果：在确定的10.591个项目中，34人符合条件。纳入的大多数文章都是原创性研究(n=15)。一半的文章和CPG关注干预类别(55%)，如护理讨论目标和舒适护理，其次是临终决策过程中需要考虑的因素（25%）和预后评估（20%），主要通过对预期寿命的估计。这些策略的证据水平仍然很低，鉴于支持他们的前瞻性研究数量有限。
结论：这项范围综述强调，对虚弱的老年髋部骨折患者的临终关怀仍未得到充分研究。确定的战略可以优先用于未来的研究，以改善目标人口的福祉，同时促进可持续的资源管理。
