Heterogeneity and changes in preferences for dying at home: a systematic review.
Heterogeneity and changes in preferences for dying at home: a systematic review.
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DOI：
10.1186/1472-684x-12-7
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发表时间：
2013-02-15
影响因子：
3.1
通讯作者：
Higginson IJ
中科院分区：
文献类型：
--
作者：
Gomes B;Calanzani N;Gysels M;Hall S;Higginson IJ
以家庭为基础的临终关怀和姑息治疗模式得到了推广，其论点是大多数人更愿意在家中死去。我们研究了家庭死亡偏好的异质性，并首次探索了偏好随疾病进展的变化。我们在MEDLINE（1966-2011），EMBASE（1980-2011），PsycINFO（1967-2011），CINAHL（1982-2011），六种姑息治疗期刊（2006-11）和参考文献列表中检索了关于成年人在生命结束或死亡时对护理地点偏好的研究。使用标准标准对研究质量和证据强度进行分级。散点图显示了患者、非专业护理人员和普通公众中倾向于在家死亡的百分比，按研究质量、年份、样本量加权。210项研究报告了来自33个国家的10万多人的偏好，其中包括34,021名患者，19,514名护理人员和29,926名普通公众。68%的定量数据研究质量较低;只有76项研究提供了用于引出偏好的问题。有适度的证据表明，大多数人更喜欢在家中死亡-这是在75%的研究中发现的，其中9/14的高质量研究。在后者中，排除离群值，患者的家庭偏好估计值范围为31%至87%（9项研究），护理人员为25%至64%（5项研究），公众为49%至70%（4项研究）。10项研究（2项高质量研究）的1395例患者中有20%改变了偏好，但未检验统计学显著性。控制方法上的弱点，我们发现证据表明，大多数人更愿意死在家里。大约五分之四的患者没有随着病情的进展而改变偏好。这支持将重点放在晚期疾病患者的家庭护理上，但敦促政策制定者为那些想法不同或改变主意的人在其他地方提供临终关怀和姑息治疗。研究必须明确偏好是如何产生的。迫切需要研究对死亡偏好的变化。
Home-based models of hospice and palliative care are promoted with the argument that most people prefer to die at home. We examined the heterogeneity in preferences for home death and explored, for the first time, changes of preference with illness progression. We searched for studies on adult preferences for place of care at the end of life or place of death in MEDLINE (1966–2011), EMBASE (1980–2011), psycINFO (1967–2011), CINAHL (1982–2011), six palliative care journals (2006–11) and reference lists. Standard criteria were used to grade study quality and evidence strength. Scatter plots showed the percentage preferring home death amongst patients, lay caregivers and general public, by study quality, year, weighted by sample size. 210 studies reported preferences of just over 100,000 people from 33 countries, including 34,021 patients, 19,514 caregivers and 29,926 general public members. 68% of studies with quantitative data were of low quality; only 76 provided the question used to elicit preferences. There was moderate evidence that most people prefer a home death–this was found in 75% of studies, 9/14 of those of high quality. Amongst the latter and excluding outliers, home preference estimates ranged 31% to 87% for patients (9 studies), 25% to 64% for caregivers (5 studies), 49% to 70% for the public (4 studies). 20% of 1395 patients in 10 studies (2 of high quality) changed their preference, but statistical significance was untested. Controlling for methodological weaknesses, we found evidence that most people prefer to die at home. Around four fifths of patients did not change preference as their illness progressed. This supports focusing on home-based care for patients with advanced illness yet urges policy-makers to secure hospice and palliative care elsewhere for those who think differently or change their mind. Research must be clear on how preferences are elicited. There is an urgent need for studies examining change of preferences towards death.