Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis.
Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis.
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DOI：
10.1001/jama.2016.16840
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发表时间：
2016-11-22
期刊：
影响因子：
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通讯作者：
Schenker Y
中科院分区：
文献类型：
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作者：
Kavalieratos D;Corbelli J;Zhang D;Dionne-Odom JN;Ernecoff NC;Hanmer J;Hoydich ZP;Ikejiani DZ;Klein-Fedyshin M;Zimmermann C;Morton SC;Arnold RM;Heller L;Schenker Y
姑息治疗计划的使用和评估其有效性的试验数量有所增加。确定姑息治疗与生活质量（QOL），症状负担，生存率和其他结果的人与生命限制性疾病及其照顾者的关联。MEDLINE、EMBASE、CINAHL和科克伦中心至2016年7月。在患有限制生命疾病的成人中进行姑息治疗干预的随机临床试验。两名评审员独立提取数据。对所有试验进行叙述性综合。生活质量、症状负担和生存率采用随机效应荟萃分析进行分析，将QOL估计值转换为慢性病治疗-姑息治疗量表的功能评估单位（FACIT-EQUIPMENT）仪器（范围，0-184 [最差-最佳];最小临床重要差异[MCID]，9分）;症状负担转换为埃德蒙顿症状评估量表（ESAS）（范围，0-90 [最佳-最差]; MCID，5.7分）。生活质量、症状负担、生存率、情绪、提前护理计划、死亡部位、医疗保健满意度、资源利用和医疗保健支出。43项随机对照试验提供了12731例患者（平均年龄67岁）和2479名护理人员的数据。35项试验使用常规护理作为对照，14项试验在门诊环境中进行。在荟萃分析中，姑息治疗与1至3个月随访时患者生活质量的统计学和临床显著改善相关（标准化平均差异，0.46; 95%CI，0.08 - 0.83; FACIT-TBI平均差异，11.36）和1- 3个月随访时的症状负担（标准化平均差异，-0.66; 95%CI，−1.25至−0.07; ESAS均值差，−10.30）。当分析仅限于低偏差风险的试验（n = 5）时，姑息治疗与生活质量之间的相关性减弱，但仍然具有统计学意义（标准化平均差异为0.20; 95%CI为0.06 - 0.34; FACIT-TBI平均差异为4.94），而与症状负担的相关性无统计学意义（标准化均值差，-0.21; 95%CI，-0.42至0.00; ESAS均值差，-3.28）。姑息治疗与生存率之间无相关性（风险比，0.90; 95%CI，0.69 - 1.17）。姑息治疗与提前护理计划、患者和护理人员满意度的改善以及较低的卫生保健利用率相关。与其他结果相关的证据好坏参半。在这项荟萃分析中，姑息治疗干预与患者生活质量和症状负担的改善相关。结果的照顾者的结果是不一致的。然而，当仅限于低偏倚风险的试验时，许多相关性不再显著，并且姑息治疗与生存率之间没有显著相关性。
The use of palliative care programs and the number of trials assessing their effectiveness have increased. To determine the association of palliative care with quality of life (QOL), symptom burden, survival, and other outcomes for people with life-limiting illness and for their caregivers. MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL to July 2016. Randomized clinical trials of palliative care interventions in adults with life-limiting illness. Two reviewers independently extracted data. Narrative synthesis was conducted for all trials. Quality of life, symptom burden, and survival were analyzed using random-effects meta-analysis, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy–palliative care scale (FACIT-Pal) instrument (range, 0–184 [worst-best]; minimal clinically important difference [MCID], 9 points); and symptom burden translated to the Edmonton Symptom Assessment Scale (ESAS) (range, 0–90 [best-worst]; MCID, 5.7 points). Quality of life, symptom burden, survival, mood, advance care planning, site of death, health care satisfaction, resource utilization, and health care expenditures. Forty-three RCTs provided data on 12 731 patients (mean age, 67 years) and 2479 caregivers. Thirty-five trials used usual care as the control, and 14 took place in the ambulatory setting. In the meta-analysis, palliative care was associated with statistically and clinically significant improvements in patient QOL at the 1- to 3-month follow-up (standardized mean difference, 0.46; 95%CI, 0.08 to 0.83; FACIT-Pal mean difference, 11.36] and symptom burden at the 1- to 3-month follow-up (standardized mean difference, −0.66; 95%CI, −1.25 to −0.07; ESAS mean difference, −10.30). When analyses were limited to trials at low risk of bias (n = 5), the association between palliative care and QOL was attenuated but remained statistically significant (standardized mean difference, 0.20; 95%CI, 0.06 to 0.34; FACIT-Pal mean difference, 4.94), whereas the association with symptom burden was not statistically significant (standardized mean difference, −0.21; 95%CI, −0.42 to 0.00; ESAS mean difference, −3.28). There was no association between palliative care and survival (hazard ratio, 0.90; 95%CI, 0.69 to 1.17). Palliative care was associated consistently with improvements in advance care planning, patient and caregiver satisfaction, and lower health care utilization. Evidence of associations with other outcomes was mixed. In this meta-analysis, palliative care interventions were associated with improvements in patient QOL and symptom burden. Findings for caregiver outcomes were inconsistent. However, many associations were no longer significant when limited to trials at low risk of bias, and there was no significant association between palliative care and survival.