背景:尽管有几种旨在促进临终对话的干预措施可用,目前尚不清楚这些因素是否以及如何影响临终对话。测量与高质量临终关怀相关的过程可能会引发改善。
目的:评估旨在促进与晚期慢性或绝症患者或其家人临床接触的临终对话的干预措施的效果,关于生命终结对话的过程指标。
方法:系统评价与荟萃分析(PROSPERO编号:CRD42021289471)。四个数据库(PubMed,CINAHL,PsycINFO,和Scopus)被搜索到2021年9月30日。主要结果是生命终结对话的任何过程指标。成对荟萃分析的结果表示为发生风险比(RR),质量的标准化平均差(SMD)和持续时间的均值比率(ROM)。当少于4项研究可用时,不进行荟萃分析。
结果:扫描了4,663篇文章。18项研究纳入系统评价,16项纳入至少一项荟萃分析:记录发生率(n=8),患者报告的发生率(n=4),患者报告质量(n=4),持续时间(n=4)。设置有显著的可变性,患者的临床状况,和专业人士。干预措施对记录在案的发生率无显著影响(RR1.54,95%CI0.84-2.84;I291%),患者报告的发生率(RR1.52,95%CI0.80-2.91;I295%),患者报告质量(SMD0.83,95%CI-1.06至2.71;I299%),发现了临终对话的持续时间(ROM1.20,95%CI0.95-1.51;I265%)。频率数据相互矛盾。针对多个利益相关者的干预措施促进了更早,更全面的对话。
结论:异质性相当大,但研究结果表明,干预措施对发生没有显著影响,患者报告的生命结束对话的质量和持续时间。然而,我们发现了针对多个利益相关者的干预措施的迹象,以促进更早和更全面的对话.
Although several interventions aimed to promote end-of-life conversations are available, it is unclear whether and how these affect delivery of end-of-life conversations. Measuring the processes associated with high-quality end-of-life care may trigger improvement.
To estimate the effect of interventions aimed to promote end-of-life conversations in clinical encounters with patients with advanced chronic or terminal illness or their family, on process indicators of end-of-life conversations.
Systematic
review with meta-analysis (PROSPERO no. CRD42021289471). Four databases (PubMed, CINAHL, PsycINFO, and Scopus) were searched up to September 30, 2021. The primary outcomes were any process indicators of end-of-life conversations. Results of pairwise meta-analyses were presented as Risk Ratio (RR) for occurrence, standardized mean difference (SMD) for quality and ratio of means (ROM) for duration. Meta-analysis was not performed when fewer than four studies were available.
A total of 4,663 articles were scanned. Eighteen studies were included in the systematic
review and 16 entered at least one meta-analysis: documented occurrence (n = 8), patient-reported occurrence (n = 4), patient-reported-quality (n = 4), duration (n = 4). There was significant variability in settings, patients\' clinical conditions, and professionals. No significant effect of interventions on documented occurrence (RR 1.54, 95% CI 0.84-2.84; I2 91%), patient-reported occurrence (RR 1.52, 95% CI 0.80-2.91; I2 95%), patient-reported quality (SMD 0.83, 95% CI -1.06 to 2.71; I2 99%), or duration (ROM 1.20, 95% CI 0.95-1.51; I2 65%) of end-of-life conversations was found. Data on frequency were conflicting. Interventions targeting multiple stakeholders promoted earlier and more comprehensive conversations.
Heterogeneity was considerable, but findings suggest no significant effect of interventions on occurrence, patient-reported quality and duration of end-of-life conversations. Nevertheless, we found indications for interventions targeting multiple stakeholders to promote earlier and more comprehensive conversations.