Timing of Goals of Care Discussions in Nursing Homes: A Systematic Review.
Timing of Goals of Care Discussions in Nursing Homes: A Systematic Review.
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DOI：
10.1016/j.jamda.2023.09.024
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发表时间：
2023-10
影响因子：
7.6
通讯作者：
Jung A. Kang;A. Tark;L. Estrada;Lara Dhingra;Patricia W. Stone
中科院分区：
文献类型：
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作者：
Jung A. Kang;A. Tark;L. Estrada;Lara Dhingra;Patricia W. Stone
目的卫生专业人员与疗养院(NH)居民或其家人讨论当前或未来的卫生保健目标可能与更好的临终结局(EOL)相关，例如避免不必要的干预或在医院死亡。这些讨论的时机各不相同，它们对EOL结果的影响可能取决于它们的时机。这项研究综合了关于NHS讨论护理目标(GOC)的时机及其对EOL结果的影响的最新证据。设计系统综述。设置和参与NH环境中的成人人口。方法本系统性综述遵循系统回顾和Meta分析指南的首选报告项目。我们检索了从2000年1月到2022年9月的PubMed、Embase和护理与相关健康累积指数。我们纳入了在NHS中考察GOC讨论时间的研究，并进行了同行评议，并以英语发表。用纽卡斯尔-渥太华量表对研究的质量进行评估。结果对1930年的摘要进行筛选，共产生149篇论文，并对其进行了合格评估。在18篇文章中，代表了16项符合审查标准的不同研究，其中12篇评估了提前指示的时机。GOC讨论的时间有差异，与在死亡一个月内进行的讨论相比，较早的讨论(例如，在设施入院时)与较低的EOL住院率和较低的医疗费用相关。结论和含义NHS讨论GOC的时间各不相同，有证据表明，讨论较晚与较差的EOL结局相关。通过更早和更频繁的讨论，目标一致护理的好处可能会得到加强。未来的研究应该检查在NH人口中进行GOC讨论的最佳时机。
ObjectivesDiscussions between health professionals and nursing home (NH) residents or their families about the current or future goals of health care may be associated with better outcomes at the end of life (EOL), such as avoidance of unwanted interventions or death in hospital. The timing of these discussions varies, and it is possible that their influence on EOL outcomes depends on their timing. This study synthesized current evidence concerning the timing of goals of care (GOC) discussions in NHs and its impact on EOL outcomes.DesignSystematic review.Setting and ParticipantsAdult populations in NH settings.MethodsThis systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. We searched PubMed, Embase, and Cumulative Index of Nursing and Allied Health from January 2000 to September 2022. We included studies that examined timing of GOC discussions in NHs, were peer-reviewed, and published in English. Quality of the studies was assessed using the Newcastle-Ottawa Scale.ResultsScreening of 1930 abstracts yielded 149 papers that were evaluated for eligibility. Of the 18 articles, representing 16 distinct studies that met review criteria, 12 evaluated the timing of advance directives. There was variation in the timing of GOC discussions and compared with discussions that occurred within a month of death, earlier discussions (eg, at the time of facility admission) were associated with lower rates of hospitalization at the EOL and lower health care costs.Conclusions and ImplicationsThe timing of GOC discussions in NHs varies and evidence suggests that late discussions are associated with poorer EOL outcomes. The benefits of goal-concordant care may be enhanced by earlier and more frequent discussions. Future studies should examine the optimal timing for GOC discussions in the NH population.