El-Jawahri Areej, Greer Joseph A, Temel Jennifer S
Bulfinch Medical Group, Massachusetts General Hospital, 15 Parkman Street, Wang Care Center, 5th floor, Suite 535, Boston, MA 02114, USA.
J Support Oncol. 2011 May-Jun;9(3):87-94. doi: 10.1016/j.suponc.2011.03.003.
Patients with incurable illness experience considerable physical and psychological distress, which negatively impacts their quality of life. Palliative care clinicians primarily seek to alleviate suffering, enhance coping with symptoms, and enable informed decision making. In this article, we review the efficacy of various palliative care interventions to improve patients' quality of life, physical and psychological symptoms, satisfaction with care, family caregiver outcomes, health-service utilization, and quality of end-of-life care. We have identified 22 randomized studies that evaluate the efficacy of various palliative care interventions. Palliative care research has been hampered by methodological challenges related to attrition and missing data due to progressive illness and death. In addition, interventions to date have varied widely in the focus and extent of services, with only eight studies entailing direct clinical care by palliative care specialists, making comparisons across trials challenging. Despite these limitations, accumulating evidence shows that palliative care interventions do improve patients' quality of life, satisfaction with care, and end-of-life outcomes. Five of seven studies which examined quality of life as a primary outcome reported a statistically significant difference favoring the palliative care intervention. Ten studies examined patient and/or family caregiver satisfaction with care, and seven of these reported greater satisfaction with palliative care intervention. However, data are lacking to support the benefit of palliative interventions for reducing patients' physical and psychological symptoms. We conclude the review by discussing the major obstacles and future directions in evaluating and implementing standardized palliative care interventions.
患有不治之症的患者会经历相当大的身体和心理痛苦，这会对他们的生活质量产生负面影响。姑息治疗临床医生主要致力于减轻痛苦、增强对症状的应对能力，并使患者能够做出明智的决策。在本文中，我们回顾了各种姑息治疗干预措施在改善患者生活质量、身体和心理症状、护理满意度、家庭照顾者结局、卫生服务利用以及临终护理质量方面的疗效。我们确定了22项评估各种姑息治疗干预措施疗效的随机研究。由于疾病进展和死亡导致的失访和数据缺失等方法学挑战，阻碍了姑息治疗研究的开展。此外，迄今为止的干预措施在服务重点和范围上差异很大，只有八项研究涉及姑息治疗专家的直接临床护理，这使得跨试验比较具有挑战性。尽管存在这些局限性，但越来越多的证据表明，姑息治疗干预措施确实能改善患者的生活质量、护理满意度和临终结局。七项将生活质量作为主要结局进行研究的研究中有五项报告称，姑息治疗干预措施在统计学上有显著差异。十项研究考察了患者和/或家庭照顾者对护理的满意度，其中七项报告称对姑息治疗干预措施的满意度更高。然而，缺乏数据支持姑息治疗干预措施在减轻患者身体和心理症状方面的益处。我们通过讨论评估和实施标准化姑息治疗干预措施的主要障碍和未来方向来结束本综述。
