Do hospital-based palliative teams improve care for patients or families at the end of life?
Do hospital-based palliative teams improve care for patients or families at the end of life?
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DOI：
10.1016/s0885-3924(01)00406-7
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发表时间：
2002-02-01
影响因子：
4.7
通讯作者：
Norman, CE
中科院分区：
文献类型：
--
作者：
Higginson, IJ;Finlay, I;Norman, CE
为了确定是否以医院为基础的姑息治疗团队改善的过程或结果的护理病人和家庭在生命的尽头，一个系统的文献进行了定性荟萃分析和定量荟萃分析。检索了10个数据库。这是通过手工搜索特定的期刊，联系作者，并检查检索到的所有论文的参考文献列表来增强的。如果研究评估了在医院工作的姑息治疗团队，则纳入研究。数据由两名独立审查员提取。使用两个独立的证据层次对研究进行分级。使用信号评分评估出版物的相关性。进行了两项分析。在定性综合集成中，将数据提取到标准化表格中，以比较相关特征和结果。在定量荟萃分析中，我们计算了每个结果的效应量（将估计的平均差异或比例差异除以样本的标准差）。九项研究专门检查了基于医院的姑息治疗团队或研究的干预。另外四项研究考虑了包括医院或支持团队组成部分的干预措施，尽管总的干预措施范围更广。干预的性质各不相同。这些研究通常在大型教学医院、城市进行，主要在英国。结果考虑症状生活质量，住院时间，姑息治疗的总时间，或专业的变化，如处方实践。其中只有一项研究是随机对照试验，并将医院团队视为其他服务的一部分。大多数方法得分表明有限的研究质量。比较组存在偏倚，分析未针对混杂变量进行调整。此外，还有磨损和样本量小的问题。然而，为了确定是否以医院为基础的姑息治疗团队改善的过程或结果的照顾病人和家庭在生命的尽头，进行了系统的文献综述采用定性荟萃分析和定量荟萃分析。检索了10个数据库。这是通过手工搜索特定的期刊，联系作者，并检查检索到的所有论文的参考文献列表来增强的。如果研究评估了在医院工作的姑息治疗团队，则纳入研究。数据由两名独立审查员提取。使用两个独立的证据层次对研究进行分级。使用信号评分评估出版物的相关性。进行了两项分析。在定性综合集成中，将数据提取到标准化表格中，以比较相关特征和结果。在定量荟萃分析中，我们计算了每个结果的效应量（将估计的平均差异或比例差异除以样本的标准差）。9项研究专门检查了包括医院或支持团队组成部分的干预措施，尽管总干预措施范围更广。干预的性质各不相同，研究通常在大型教学医院进行，在城市，主要是在英国。结局考虑生活质量、住院时间、姑息治疗的总时间或专业变化，如处方实践。其中只有一项研究是随机对照试验，并将医院团队视为其他服务的一部分。大多数方法得分表明有限的研究质量。比较组存在偏倚，分析未针对混杂变量进行调整。此外，还有磨损和样本量小的问题。尽管如此，所有研究都表明医院的积极作用很小，除了意大利的一项研究，该研究记录了患者症状的恶化。信号评分表明研究具有相关性。没有研究比较不同的医院团队模式。这篇综述表明，以医院为基础的姑息治疗团队提供了一些好处，但这一发现应谨慎解释。研究设计需要改进，并且需要比较在医院临终时提供支持的不同模式。在这类研究和实践中应采用标准化的结果衡量标准。(C)美国癌症疼痛缓解委员会，2002年。
To determine whether hospital-based palliative care teams improve the process or outcomes of care for patients and families at the end of life, a systematic literature was performed employing a qualitative meta-synthesis and quantitative meta-analysis. Ten databases were searched. This was augmented by hand searching specific journals, contacting authors, and examining the reference lists of all papers retrieved. Studies were included if they evaluated palliative care teams working in hospitals. Data were extracted by two independent reviewers. Studies were graded using two independent hierarchies of evidence. A Signal score was used to assess the relevance of publications. Two analyses were conducted. In a qualitative meta-synthesis data were extracted into standardized tables to compare relevant features and findings. In quantitative meta-analysis we calculated the effect size of each outcome (dividing the estimated mean difference or difference in proportions by the sample's standard deviation). Nine studies specifically examined the intervention of a hospital-based palliative care team or studies. A further four studies considered interventions that included a component of a hospital or support team, although the total intervention was broader. The nature of the interventions varied. The studies were usually in large teaching hospitals, in cities, and mainly in the United Kingdom. Outcomes considered symptoms quality of life, time in hospital, total length of time in palliative care, or professional changes, such as prescribing practices. Only one of the studies was a randomized controlled trial and this considered a hospital team as part of other services. Most method scores indicated limited research quality. Comparison groups were subject to bias and analyses were not adjusted for confounding variables. In addition, there were problems of attrition and small sample sizes. Nevertheless,To determine whether hospital-based palliative care teams improve the process or outcomes of care for patients and families at the end of life, a systematic literature review was performed employing a qualitative meta-synthesis and quantitative meta-analysis. Ten databases were searched. This was augmented by hand searching specific journals, contacting authors, and examining the reference lists of all papers retrieved. Studies were included if they evaluated palliative care teams working in hospitals. Data were extracted by two independent reviewers. Studies were graded using two independent hierarchies of evidence. A Signal score was used to assess the relevance of publications. Two analyses were conducted. In a qualitative meta-synthesis data were extracted into standardized tables to compare relevant features and findings. In quantitative meta-analysis we calculated the effect size of each outcome (dividing the estimated mean difference or difference in proportions by samples's standard deviation). Nine studies specifically examined the intervention that included a component of a hospital or support team, although the total intervention was broader. The nature of the interventions varied.The studies were usually in large teaching hospitals., in cities, and mainly in the United Kingdom. Outcomes considered quality of life, time in hospital, total length of time in palliative care, or professional changes, such as prescribing practices. Only one of the studies was a randomized controlled trial and this considered a hospital team as part of other services. Most method scores indicated limited research quality. Comparison groups were subject to bias and the analyses were not adjusted for confounding variables. In addition, there were problems of attrition and small sample sizes. Nevertheless, all studies indicated a small positive effect of the hospital, except for one study in Italy, which documented deterioration in patient symptoms. The Signal scores indicated that the studies were relevant. No study compared different models of hospital team. This review suggests that hospital-based palliative care teams offer some benefits, although this finding should be interpreted with caution. The study designs need to be improved and different models of providing support at the end of life in hospital need comparison. Standardized outcome measures should be used in such research and in practice. (C) U.S. Cancer Pain Relief Committee, 2002.