Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem
Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem
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DOI：
10.1093/intqhc/mzw060
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发表时间：
2016-09-01
影响因子：
2.6
通讯作者：
Hillman, K.
中科院分区：
文献类型：
--
作者：
Cardona-Morrell, M.;Kim, J. C. H.;Hillman, K.
目的：探讨医院常规护理患者生命最后6个月任何时间客观“非有益治疗（nbt）”（过多）的程度。数据来源：Medline、EMBASE、PubMed、Cochrane图书馆的英文出版物和灰色文献（1995年1月- 2015年4月）。研究选择：所有研究类型评估对老年人生命末期（EOL）实施的非有益的医学或外科诊断、治疗或非姑息性程序的客观维度。数据提取：由两位作者独立估计的13项质量评分。数据综合结果：来自38项研究的证据表明，平均33-38%接近EOL的患者接受了nbt。晚期患者的平均复苏率为28%（范围11-90%）。重症监护病房（ICU）平均死亡率为42%（范围11-90%）；病房平均死亡率为44.5%（29 ~ 60%）。包括透析、放疗、输血和生命支持治疗在内的积极措施对晚期患者的平均患病率为7-77%（平均30%）。死亡患者给予抗生素、心血管、消化和内分泌治疗无效的发生率为11-75%（平均38%）。对33-50%的无复苏指令患者进行了非有益测试。从荟萃分析来看，非有益ICU住院的总患病率为10% (95% CI 0-33%)；在生命最后6周接受化疗的患者占33% （95% CI 24-41%）。结论：本综述证实了nbt在急症医院EOL的广泛应用。虽然一定程度的非技术性贸易壁垒是不可避免的，但其范围、变化和理由需要进一步审查。
Purpose: To investigate the extent of objective 'non-beneficial treatments (NBTs)' (too much) anytime in the last 6 months of life in routine hospital care.Data sources: English language publications in Medline, EMBASE, PubMed, Cochrane library, and the grey literature (January 1995-April 2015).Study selection: All study types assessing objective dimensions of non-beneficial medical or surgical diagnostic, therapeutic or non-palliative procedures administered to older adults at the end of life (EOL).Data extraction: A 13-item quality score estimated independently by two authors.Results of data synthesis: Evidence from 38 studies indicates that on average 33-38% of patients near the EOL received NBTs. Mean prevalence of resuscitation attempts for advanced stage patients was 28% (range 11-90%). Mean death in intensive care unit (ICU) was 42% (range 11-90%); and mean death rate in a hospital ward was 44.5% (range 29-60%). Mean prevalence of active measures including dialysis, radiotherapy, transfusions and life support treatment to terminal patient was 7-77% (mean 30%). Non-beneficial administration of antibiotics, cardiovascular, digestive and endocrine treatments to dying patients occurred in 11-75% (mean 38%). Non-beneficial tests were performed on 33-50% of patients with do-not-resuscitate orders. From meta-analyses, the pooled prevalence of non-beneficial ICU admission was 10% (95% CI 0-33%); for chemotherapy in the last six weeks of life was 33% (95% CI 24-41%).Conclusion: This review has confirmed widespread use of NBTs at the EOL in acute hospitals. While a certain level of NBT is inevitable, its extent, variation and justification need further scrutiny.