背景:癌症和慢性心力衰竭(CHF)/慢性阻塞性肺疾病(COPD)患者在获得姑息治疗(PC)服务方面存在明显的不平等,这也转化为PC整合水平的差异。通过交叉检查欧洲已发布的CHF/COPD和癌症指南/途径中的PC整合水平,这项研究调查了这些差异是否可能归因于指南的内容。
方法:在欧洲发表的癌症指南和CHF/COPD指南中对综合PC进行了定量评估。使用11点综合PC标准工具(IPC标准)测量指南/途径中综合PC的含量。进行统计分析以检测两组之间综合PC水平的相似性和差异性。
结果:CHF/COPD与癌症指南/途径之间的整合水平在统计学上相似。此外,所利用的证据质量和指南/途径的制定日期似乎不影响指南中的PC整合.
结论:在欧洲,根据经验观察到的癌症和CHF/COPD患者在PC整合方面的失衡可能仅部分归因于用于PC实施的指南/途径的内容.鉴于癌症和CHF/COPD之间的相似性,其他障碍似乎发挥了更突出的作用。
BACKGROUND: There is a notable inequity in access to palliative care (PC) services between cancer and Chronic Heart Failure (CHF)/Chronic Obstructive Pulmonary Disease (COPD) patients which also translates into discrepancies in the level of integration of PC. By cross-examining the levels of PC integration in published
guidelines/pathways for CHF/COPD and cancer in Europe, this study examines whether these discrepancies may be attributed to the content of the guidelines.
METHODS: A quantitative evaluation was made between
integrated PC in published
guidelines for cancer and CHF/COPD in Europe. The content of
integrated PC in
guidelines/pathways was measured using an 11 point
integrated PC criteria tool (IPC criteria). A statistical analysis was carried out to detect similarities and differences in the level of
integrated PC between the two groups.
RESULTS: The levels of integration between CHF/COPD and cancer guidelines/pathways have been shown to be statistically similar. Moreover, the quality of evidence utilized and the date of development of the guidelines/pathways appear not to impact upon the PC integration in the
guidelines.
CONCLUSIONS: In Europe, the empirically observed imbalance in integration of PC for patients with cancer and CHF/COPD may only partially be attributed to the content of the guidelines/pathways that are utilized for the PC implementation. Given the similarities detected between cancer and CHF/COPD, other barriers appear to play a more prominent role.