Effect of specialist palliative care services on quality of life in adults with advanced incurable illness in hospital, hospice, or community settings: systematic review and meta-analysis
Effect of specialist palliative care services on quality of life in adults with advanced incurable illness in hospital, hospice, or community settings: systematic review and meta-analysis
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DOI：
10.1136/bmj.j2925
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发表时间：
2017-07-04
影响因子：
105.7
通讯作者：
Becker, Gerhild
中科院分区：
文献类型：
--
作者：
Gaertner, Jan;Siemens, Waldemar;Becker, Gerhild
目的：评估专科姑息治疗对晚期疾病患者生活质量和其他相关结局的影响。数据来源：Medline、Embase、科克伦对照试验中心登记处、PsycINFO和试验登记处，检索至2016年7月。选择研究的资格标准：随机对照试验，成年住院患者或门诊患者在医院、临终关怀机构、或社区环境中的任何晚期疾病。专家姑息治疗的最低要求包括多专业团队的方法。两名评价者独立筛选和提取数据，评估偏倚风险（科克伦偏倚风险工具），评估证据质量（GRADE工具）。数据分析主要结局为生活质量，荟萃分析采用Hedges 'g作为标准化均数差（SMD）和随机效应模型。此外，在总体健康/QoL量表上重新表达了生活质量分析的汇总SMD欧洲癌症研究和治疗组织QLQ-C30（分别为项目29和30）（0 - 100，高值=良好的生活质量，最小的临床重要差异8.1）。纳入了12项（10项随机对照试验，随机分配了2454例患者，其中72%（n = 1766）患有癌症）。在任何试验中，都没有根据筛选确定的患者需求触发专家姑息治疗的整合。总体而言，专家姑息治疗的效果较小（SMD 0.16，95%置信区间0.01 - 0.31; QLQ-C30总体健康/QoL 4.1，0.3 - 8.2; n = 1218，6项试验）。敏感性分析显示SMD为0.57（-0.02至1.15;总体健康/QoL为14.6，-0.5至29.4; n = 1385，7项试验）。癌症患者的影响略大（0.20，0.01 - 0.38;总体健康/生活质量5.1，0.3 - 9.7; n = 828，5项试验），尤其是早期接受专科姑息治疗的患者（0.33，0.05 - 0.61，总体健康/生活质量8.5，1.3 - 15.6; n = 388，2项试验）。疼痛和其他次要结局的结果不确定。一些方法上的问题（如缺乏盲法）降低了强度的evidence.CONCLUSIONSPECIAL姑息治疗与生活质量的一个小的影响，并可能有最明显的影响，癌症患者谁收到这样的护理早期。如果能尽早提供，并且通过筛查发现那些需求未得到满足的患者，则可能最有效。
OBJECTIVETo assess the effect of specialist palliative care on quality of life and additional outcomes relevant to patients in those with advanced illness.DESIGNSystematic review with meta-analysis.DATA SOURCESMedline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and trial registers searched up to July 2016.ELIGIBILITY CRITERIA FOR SELECTING STUDIESRandomised controlled trials with adult inpatients or outpatients treated in hospital, hospice, or community settings with any advanced illness. Minimum requirements for specialist palliative care included the multiprofessional team approach. Two reviewers independently screened and extracted data, assessed the risk of bias (Cochrane risk of bias tool), and evaluated the quality of evidence (GRADE tool).DATA SYNTHESISPrimary outcome was quality of life with Hedges'g as standardised mean difference (SMD) and random effects model in meta-analysis. In addition, the pooled SMDs of the analyses of quality of life were re-expressed on the global health/QoL scale (item 29 and 30, respectively) of the European Organization for Research and Treatment of Cancer QLQ-C30 (0-100, high values=good quality of life, minimal clinically important difference 8.1).RESULTSOf 3967 publications, 12 were included (10 randomised controlled trials with 2454 patients randomised, of whom 72% (n=1766) had cancer). In no trial was integration of specialist palliative care triggered according to patients' needs as identified by screening. Overall, there was a small effect in favour of specialist palliative care (SMD 0.16, 95% confidence interval 0.01 to 0.31; QLQ-C30 global health/QoL 4.1, 0.3 to 8.2; n=1218, six trials). Sensitivity analysis showed an SMD of 0.57 (-0.02 to 1.15; global health/QoL 14.6, -0.5 to 29.4; n=1385, seven trials). The effect was marginally larger for patients with cancer (0.20, 0.01 to 0.38; global health/QoL 5.1, 0.3 to 9.7; n=828, five trials) and especially for those who received specialist palliative care early (0.33, 0.05 to 0.61, global health/QoL 8.5, 1.3 to 15.6; n=388, two trials). The results for pain and other secondary outcomes were inconclusive. Some methodological problems (such as lack of blinding) reduced the strength of the evidence.CONCLUSIONSSpecialist palliative care was associated with a small effect on QoL and might have most pronounced effects for patients with cancer who received such care early. It could be most effective if it is provided early and if it identifies though screening those patients with unmet needs.SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015020674.