Identifying Core Domains to Assess the "Quality of Death": A Scoping Review.
Identifying Core Domains to Assess the "Quality of Death": A Scoping Review.
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确定评估“死亡质量”的核心领域：范围界定审查。
DOI：
10.1016/j.jpainsymman.2021.11.015
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发表时间：
2022
影响因子：
4.7
通讯作者：
Finkelstein,EricA
中科院分区：
文献类型：
--
作者：
Bhadelia,Afsan;Oldfield,LeslieE;Cruz,JenniferL;Singh,Ratna;Finkelstein,EricA
背景提供包括临终关怀在内的医疗保健对患者、家庭、社会和卫生系统的价值日益得到认可，这与患者的偏好和临床指南是一致的。目的确定可用于评估卫生系统内部和跨卫生系统的临终关怀性能的核心域和子域。方法检索PubMed/MEDLINE(NCBI)、SqucINFO(ProQuest)和CINAHL(EBSCO)数据库，查找2020年2月22日之前发表的同行评议的期刊文章。蜘蛛工具被用来确定搜索词。结果在2728篇离散结果中，共有309篇符合条件的文章被确定。这些文章代表了更广泛的卫生系统(11)、患者(70)、家庭和非正式护理人员(65)、医疗保健专业人员(43)、多角度(110)和其他(10)的观点。最常见的疾病是癌症(103例)，大多数研究(245例)集中在高收入国家的情况下。审查确定了5个领域和11个分领域，侧重于与更广泛的保健系统一级的临终关怀有关的结构性因素，2个领域和22个分领域侧重于从病人和家庭的角度进行临终关怀的经验方面。卫生系统的结构性领域是：1)管理和治理，2)资源创造，3)筹资和财政保护，4)服务提供，5)获得护理。经验领域是：1)护理质量，2)沟通质量。结论综述肯定了需要以人为中心的方法来管理接受和准备临终的微妙过程和时期。已确定的与“死亡质量”有关的结构性和经验性因素将对今后旨在量化临终阶段卫生系统绩效的努力证明是非常宝贵的。
ContextThere is growing recognition of the value to patients, families, society, and health systems in providing healthcare, including end-of-life care, that is consistent with both patient preferences and clinical guidelines.ObjectivesIdentify the core domains and subdomains that can be used to evaluate the performance of end-of-life care within and across health systems.MethodsPubMed/MEDLINE (NCBI), PsycINFO (ProQuest), and CINAHL (EBSCO) databases were searched for peer-reviewed journal articles published prior to February 22, 2020. The SPIDER tool was used to determine search terms. A priori criteria were followed with independent review to identify relevant articles.ResultsA total of 309 eligible articles were identified out of 2728 discrete results. The articles represent perspectives from the broader health system (11), patients (70), family and informal caregivers (65), healthcare professionals (43), multiple viewpoints (110), and others (10). The most common condition of focus was cancer (103) and the majority (245) of the studies concentrated on high-income country contexts. The review identified five domains and 11 subdomains focused on structural factors relevant to end-of-life care at the broader health system level, and two domains and 22 subdomains focused on experiential aspects of end-of-life care from the patient and family perspectives. The structural health system domains were: 1) stewardship and governance, 2) resource generation, 3) financing and financial protection, 4) service provision, and 5) access to care. The experiential domains were: 1) quality of care, and 2) quality of communication.ConclusionThe review affirms the need for a people-centered approach to managing the delicate process and period of accepting and preparing for the end of life. The identified structural and experiential factors pertinent to the “quality of death” will prove invaluable for future efforts aimed to quantify health system performance in the end-of-life period.