目标:在整个历史中都有关于生命终结的梦和愿景(ELDVs)的报道。我们的目的是综合关于ELDV的研究文献,以确定患者的比例,失去亲人的家庭,医疗保健专业人员,和志愿者报告ELDV;ELDV内容,定时,和解释;以及任何基于证据的ELDV相关护理方法。
方法:系统评价方案在PROSPERO(CRD4021282929)注册。CINAHL,Medline,Embase,Emcare,和APAPsycInfo进行了同行评审的英语文章报告定性,定量,或探索患者ELDV报告的混合方法研究,失去亲人的家庭,医疗保健专业人员,或志愿者。综合使用了荟萃分析和叙事方法。
结果:在通过搜索确定的2,045篇论文中,包括22人,描述了各种环境下的18项研究。荟萃分析表明,77%(95%置信区间[CI]69-84%)的患者(n=119)报告了ELDV,而有32%(95%CI=21-44%)的丧亲亲属(n=2,444)和80%(95%CI=59-94%)的医疗保健专业人员(n=171)报告了在过去5年中目睹或被告知了ELDV。对志愿者的研究报告了34%(95%CI=20-48%)(n=45)在整个服务期间目睹或被告知ELDV,49%的志愿者(95%CI=33-64%)(n=39)报告前一年发生的事件。患者报告的ELDV,失去亲人的家庭,医疗保健专业人员,志愿者被认为是安慰的来源。医疗保健专业人员和志愿者表示需要进一步教育如何支持经历ELDV的患者及其家人。
结论:大多数垂死的患者都经历过ELDV,在提供整体的临终关怀时需要考虑。在急性护理机构中进行的研究很少。
OBJECTIVE: End-of-life dreams and visions (ELDVs) have been reported throughout history. We aimed to synthesize the research literature on ELDVs to determine the proportions of patients, bereaved families, healthcare professionals, and volunteers reporting ELDVs; ELDV content, timing, and interpretation; and any evidence-based approaches to ELDV-related care.
METHODS: A systematic review protocol was registered with PROSPERO (CRD4021282929). CINAHL, Medline, Embase, Emcare, and APA PsycInfo were searched for peer-reviewed English language articles reporting qualitative, quantitative, or mixed methods studies that explored reports of ELDVs by patients, bereaved families, healthcare professionals, or volunteers. Synthesis used both meta-analysis and a narrative approach.
RESULTS: Of 2,045 papers identified by searches, 22 were included, describing 18 studies in a variety of settings. Meta-analyses indicated that 77% (95% confidence intervals [CIs] 69-84%) of patients (n = 119) reported an ELDV compared with 32% (95% CIs 21-44%) of bereaved relatives (n = 2,444) and that 80% (95% CIs 59-94%) of healthcare professionals (n = 171) reported either witnessing or being told of an ELDV in the preceding 5 years. Studies of volunteers reported 34% (95% CIs 20-48%) (n = 45) either witnessing or being told of an ELDV over their entire period of service, with 49% of volunteers (95% CIs 33-64%) (n = 39) reporting events occurring in the preceding year. ELDVs reported by patients, bereaved families, healthcare professionals, and volunteers were perceived as being a source of comfort. Healthcare professionals and volunteers expressed a need for further education on how to support patients experiencing ELDVs and their families.
CONCLUSIONS: ELDVs are experienced by the majority of dying patients and need consideration in delivering holistic end-of-life care. Little if any research has been conducted in acute care facilities.