White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European Association for Palliative Care
White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European Association for Palliative Care
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DOI：
10.1177/0269216313493685
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发表时间：
2014-03-01
影响因子：
4.4
通讯作者：
Volicer, Ladislav
中科院分区：
文献类型：
--
作者：
van der Steen, Jenny T.;Radbruch, Lukas;Volicer, Ladislav
背景：痴呆是一种限制生命的疾病，没有治愈性治疗。患者和家属可能需要姑息治疗具体到demential.Aim：确定最佳姑息治疗demential.Methods：五轮德尔菲研究。根据文献，来自6个国家的12名专家组成的核心小组起草了一套核心领域，对每个领域提出了突出建议。我们邀请了来自27个国家的89位专家，在两轮在线调查中对这些建议进行评估，并提供反馈。根据预定义的标准确定共识。第四轮涉及的核心团队的决定，第五次涉及的输入从欧洲姑息治疗协会。结果：共有64（72%）来自23个国家的专家评估了一组11个领域和57条建议。在以下八个领域立即达成了全面共识，包括建议：以人为本的护理、沟通和共同决策;最佳症状治疗和提供舒适（这两项被确定为护理和研究的核心）;确定护理目标和预先规划;护理的连续性;心理社会和精神支持;家庭护理和参与;保健团队的教育;社会和伦理问题。修订后，对死亡的解释和及时识别也达成了充分的共识。营养和脱水（避免过于积极，繁重或徒劳的治疗）和痴呆症阶段的护理目标（姑息治疗的适用性）的建议取得了温和的consensus.Conclusion：我们提供了第一个定义的姑息治疗痴呆症的基础上的证据和共识，一个框架，为临床实践，政策和研究提供指导。
Background: Dementia is a life-limiting disease without curative treatments. Patients and families may need palliative care specific to dementia.Aim: To define optimal palliative care in dementia.Methods: Five-round Delphi study. Based on literature, a core group of 12 experts from 6 countries drafted a set of core domains with salient recommendations for each domain. We invited 89 experts from 27 countries to evaluate these in a two-round online survey with feedback. Consensus was determined according to predefined criteria. The fourth round involved decisions by the core team, and the fifth involved input from the European Association for Palliative Care.Results: A total of 64 (72%) experts from 23 countries evaluated a set of 11 domains and 57 recommendations. There was immediate and full consensus on the following eight domains, including the recommendations: person-centred care, communication and shared decision-making; optimal treatment of symptoms and providing comfort (these two identified as central to care and research); setting care goals and advance planning; continuity of care; psychosocial and spiritual support; family care and involvement; education of the health care team; and societal and ethical issues. After revision, full consensus was additionally reached for prognostication and timely recognition of dying. Recommendations on nutrition and dehydration (avoiding overly aggressive, burdensome or futile treatment) and on dementia stages in relation to care goals (applicability of palliative care) achieved moderate consensus.Conclusion: We have provided the first definition of palliative care in dementia based on evidence and consensus, a framework to provide guidance for clinical practice, policy and research.