Marie Curie Palliative Care Research Unit, Department of Mental Health Sciences, Royal Free Campus, University College London, United Kingdom.
J Card Fail. 2011 Mar;17(3):231-52. doi: 10.1016/j.cardfail.2010.10.003. Epub 2010 Dec 3.
People with advanced heart failure (HF) have demonstrable supportive and palliative care needs. Effective service configuration and delivery should be informed by the views of those with personal experience and knowledge and should be based on available evidence. This systematic literature review aimed to collate qualitative and quantitative evidence on: 1) patients' perceived needs and experiences of care provision; and 2) the perspectives and understanding of health professionals on care delivery.
A systematic literature search using Medline, Embase, Cinahl, Psycinfo, and Amed identified 48 relevant studies. Data extraction and quality evaluation for included studies were conducted by 2 independent reviewers. Findings were grouped according to themes generated from the qualitative studies. Key findings were that advanced HF patients report little discussion with health professionals about their clinical status and sense a lack of timely support to accommodate their evolving needs. Health professionals report poor multidisciplinary communication and lack confidence both in diagnosing advanced HF and in communicating a poor prognosis to those affected, affecting the provision of good-quality coordinated care.
This review demonstrates the need for improvement in coordination of care and communication between patients, their families, and health care professionals. However, although there is broad agreement between the disciplines of cardiology and palliative care regarding the provision of therapies to reduce symptoms, improve function, and enhance quality of life, differences in views may arise, particularly regarding the maintenance of life-prolonging treatment as goals of care change.
患有晚期心力衰竭（HF）的患者有明显的支持和姑息治疗需求。有效的服务配置和提供应该由具有个人经验和知识的人的观点来告知，并应基于现有证据。本系统的文献综述旨在整理定性和定量证据：1）患者对护理服务的感知需求和体验；以及 2）卫生专业人员对护理服务的看法和理解。
使用 Medline、Embase、Cinahl、Psycinfo 和 Amed 进行系统文献检索，确定了 48 项相关研究。由 2 名独立审查员对纳入研究进行数据提取和质量评估。根据定性研究中生成的主题对研究结果进行分组。主要发现是，晚期 HF 患者很少与卫生专业人员讨论他们的临床状况，并且感到缺乏及时的支持来适应他们不断变化的需求。卫生专业人员报告说，多学科间的沟通不畅，缺乏诊断晚期 HF 的信心，也缺乏向受影响者传达预后不良的信心，这影响了高质量协调护理的提供。
本综述表明需要改善患者、其家属和卫生保健专业人员之间的护理协调和沟通。然而，尽管心脏病学和姑息治疗学科在提供减轻症状、改善功能和提高生活质量的治疗方法方面存在广泛共识，但在观点上可能存在差异，特别是在维持延长生命的治疗作为治疗目标发生变化时。
