Place of care in advanced cancer: a qualitative systematic literature review of patient preferences.
Place of care in advanced cancer: a qualitative systematic literature review of patient preferences.
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DOI：
10.1089/jpm.2000.3.287
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发表时间：
2000-01-01
影响因子：
2.8
通讯作者：
Sen-Gupta, G J
中科院分区：
文献类型：
--
作者：
Higginson, I J;Sen-Gupta, G J
背景：人们普遍认为，希望在家中死亡的患者比目前实现的要多。然而，关于临终关怀和死亡地点偏好的证据尚未得到系统审查。目的：对晚期癌症患者对护理地点和死亡的偏好进行系统的文献综述。方法：采用MEDLINE（1966-1999）、PsychLit（1974-1999）和Bath Information Data Service（1981-1999）的系统数据库进行检索。根据NHS审查和传播中心的指导方针对研究进行评估，提取和综合数据，根据设计和方法的严谨性对研究进行分级。研究对象包括普通人群以及癌症患者和/或其护理人员。结果：18项研究确定了一般人群或包括癌症患者在内的群体的偏好。从患者、普通人群、家庭和专业人员中获得前瞻性和回顾性的观点。受访者表示更倾向于在家死亡（范围为49%-100%），除了一项针对在伦敦接受持续护理团队护理的患者的研究外，只有25%-29%的患者希望在家死亡，住院安宁疗护是最受欢迎的选择。然而，本研究的有效率尚不清楚。在一般公众中，最近经历过亲密朋友或亲戚死亡或濒临死亡的人更倾向于住院安宁疗护。在比较患者、家属和专业人员的观点时，尽管患者表达了最强烈的家庭偏好，但所有受访者都大致同意。只有2项研究提供了纵向数据，18项研究中有9项在设计或报告上存在重大缺陷，如不良或未知的反应率，不清楚或不系统的方法来引出偏好或其他样本或测量偏差。然而，仅对更强大和更大规模的研究进行敏感性分析并没有改变超过50%的患者在生命结束时倾向于家庭护理的发现。结论：家庭护理是最常见的选择，晚期患者的第二选择是住院安宁疗护。满足这些偏好可能是服务的重要结果。这方面的研究设计有待改进。
BACKGROUND: It is commonly written that more patients wish to die at home than currently achieve this. However, the evidence for preferences for place of terminal care and death has not been systematically reviewed.AIM: To carry out a systematic literature review of the preferences for place of care and death among advanced cancer patients.METHOD: Studies were identified using systematic database searches of MEDLINE (1966-1999), PsychLit (1974-1999), and Bath Information Data Service (BIDS) (1981-1999). Studies were assessed and data extracted and synthesises following the NHS Centre for Reviews and Dissemination guidelines, grading studies according to design and rigor of methods. Studies of preferences in the general population and of groups including cancer patients and/or their caregivers were included.RESULTS: Eighteen studies determining preferences in either the general population or groups including cancer patients were identified. Views were obtained prospectively and retrospectively from patients, the general population, families, and professionals. Respondents indicated preferences for home death (range 49%-100%), except one study of patients in the care of a continuing care team in London where only 25%-29% of patients wanted a home death, and inpatient hospice was the most favored option. However, the response rate of this study was not known. Among the general public there was a higher preference for inpatient hospice care among in people with recent experience of a close friend or relative's death or dying. Where the views of patients, families, and professionals were compared, all respondents broadly agreed although patients expressed the strongest home preferences. Only 2 of the studies provided longitudinal data, and 9 of the 18 had major deficits in design or reporting, such as poor or unknown response rate, unclear or unsystematic methods of eliciting preferences or other sample or measurement bias. However, sensitivity analysis of only the more robust and larger studies did not alter the finding of a preference for home care at the end of life in over 50% of patients.CONCLUSIONS: Home care is the most common preference, with inpatient hospice care as second preference in advanced illness. Meeting these preferences could be important outcomes for services. Study designs in this area need to be improved.