终末期心力衰竭患者的临终关怀对话：系统文献回顾和叙事综合。
End-of-life care conversations with heart failure patients: a systematic literature review and narrative synthesis.
机构信息
General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, Institute of Public Health, Cambridge.
出版信息
Br J Gen Pract. 2011 Jan;61(582):e49-62. doi: 10.3399/bjgp11X549018.
BACKGROUND
Current models of end-of-life care (EOLC) have been largely developed for cancer and may not meet the needs of heart failure patients.
AIM
To review the literature concerning conversations about EOLC between patients with heart failure and healthcare professionals, with respect to the prevalence of conversations; patients' and practitioners' preferences for their timing and content; and the facilitators and blockers to conversations.
DESIGN OF STUDY
Systematic literature review and narrative synthesis.
METHOD
Searches of Medline, PsycINFO and CINAHL databases from January 1987 to April 2010 were conducted, with citation and journal hand searches. Studies of adult patients with heart failure and/or their health professionals concerning discussions of EOLC were included: discussion and opinion pieces were excluded. Extracted data were analysed using NVivo, with a narrative synthesis of emergent themes.
RESULTS
Conversations focus largely on disease management; EOLC is rarely discussed. Some patients would welcome such conversations, but many do not realise the seriousness of their condition or do not wish to discuss end-of-life issues. Clinicians are unsure how to discuss the uncertain prognosis and risk of sudden death; fearing causing premature alarm and destroying hope, they wait for cues from patients before raising EOLC issues. Consequently, the conversations rarely take place.
CONCLUSION
Prognostic uncertainty and high risk of sudden death lead to EOLC conversations being commonly avoided. The implications for policy and practice are discussed: such conversations can be supportive if expressed as 'hoping for the best but preparing for the worst'.
背景
目前的临终关怀（EOLC）模式主要是为癌症患者开发的，可能无法满足心力衰竭患者的需求。
目的
回顾有关心力衰竭患者和医疗保健专业人员之间 EOLC 对话的文献，内容涉及对话的普遍性；患者和从业者对其时间和内容的偏好；以及对话的促进因素和障碍。
研究设计
系统文献回顾和叙述性综合。
方法
对 1987 年 1 月至 2010 年 4 月的 Medline、PsycINFO 和 CINAHL 数据库进行了检索，并进行了引文和期刊手工检索。纳入了关于心力衰竭患者和/或其卫生专业人员讨论 EOLC 的成人患者的研究：排除了讨论和意见文章。使用 NVivo 分析提取的数据，并对出现的主题进行叙述性综合。
结果
对话主要集中在疾病管理上；很少讨论 EOLC。一些患者会欢迎这样的对话，但许多人没有意识到自己病情的严重性，或者不想讨论临终问题。临床医生不确定如何讨论不确定的预后和突然死亡的风险；他们担心引起过早的警报和破坏希望，因此等待患者发出信号后再提出 EOLC 问题。因此，对话很少发生。
结论
预后的不确定性和突然死亡的高风险导致 EOLC 对话普遍被回避。讨论了对政策和实践的影响：如果将这些对话表述为“希望最好，但为最坏做准备”，则可以提供支持。
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