Shepperd Sasha, Wee Bee, Straus Sharon E
Department of Public Health, University of Oxford, Rosemary Rue Building, Headington, Oxford, Oxfordshire, UK, OX3 7LF.
Cochrane Database Syst Rev. 2011 Jul 6(7):CD009231. doi: 10.1002/14651858.CD009231.
The policy in a number of countries is to provide people with a terminal illness the choice of dying at home. This policy is supported by surveys indicating that the general public and patients with a terminal illness would prefer to receive end of life care at home.
To determine if providing home-based end of life care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs and care givers compared with inpatient hospital or hospice care.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library) to October 2009, Ovid MEDLINE(R) 1950 to March 2011, EMBASE 1980 to October 2009, CINAHL 1982 to October 2009 and EconLit to October 2009. We checked the reference lists of articles identified for potentially relevant articles.
Randomised controlled trials, interrupted time series or controlled before and after studies evaluating the effectiveness of home-based end of life care with inpatient hospital or hospice care for people aged 18 years and older.
Two authors independently extracted data and assessed study quality. We combined the published data for dichotomous outcomes using fixed-effect Mantel-Haenszel meta-analysis. When combining outcome data was not possible we presented the data in narrative summary tables.
We included four trials in this review. Those receiving home-based end of life care were statistically significantly more likely to die at home compared with those receiving usual care (RR 1.33, 95% CI 1.14 to 1.55, P = 0.0002; Chi (2) = 1.72, df = 2, P = 0.42, I(2) = 0% (three trials; N=652)). We detected no statistically significant differences for functional status (measured by the Barthel Index), psychological well-being or cognitive status, between patients receiving home-based end of life care compared with those receiving standard care (which included inpatient care). Admission to hospital while receiving home-based end of life care varied between trials and this was reflected by high levels of statistically significant heterogeneity in this analysis. There was some evidence of increased patient satisfaction with home-based end of life care, and little evidence of the impact this form of care has on care givers.
AUTHORS' CONCLUSIONS: The evidence included in this review supports the use of end of life home-care programmes for increasing the number of patients who will die at home, although the numbers of patients being admitted to hospital while receiving end of life care should be monitored. Future research should also systematically assess the impact of end of life home care on care givers.
许多国家的政策是让身患绝症的人选择在家中离世。这项政策得到了调查的支持，这些调查表明，普通公众和绝症患者更愿意在家中接受临终关怀。
确定提供居家临终关怀是否会降低在医院死亡的可能性，以及与住院或临终关怀机构护理相比，这对患者症状、生活质量、医疗服务成本和护理人员有何影响。
我们检索了截至2009年10月的Cochrane对照试验中心注册库（CENTRAL）（Cochrane图书馆）、1950年至2011年3月的Ovid MEDLINE(R)、1980年至2009年10月的EMBASE、1982年至2009年10月的CINAHL以及截至2009年10月的EconLit。我们检查了已识别文章的参考文献列表，以查找潜在相关文章。
随机对照试验、中断时间序列或前后对照研究，评估居家临终关怀与住院或临终关怀机构护理对18岁及以上人群的有效性。
两位作者独立提取数据并评估研究质量。我们使用固定效应Mantel-Haenszel荟萃分析合并二分结局的已发表数据。当无法合并结局数据时，我们在叙述性汇总表中呈现数据。
本综述纳入了四项试验。与接受常规护理的患者相比，接受居家临终关怀的患者在统计学上更有可能在家中死亡（相对风险1.33，95%置信区间1.14至1.55，P = 0.0002；卡方 = 1.72，自由度 = 2，P = 0.42，I² = 0%（三项试验；N = 652））。在功能状态（用Barthel指数衡量）、心理健康或认知状态方面，接受居家临终关怀的患者与接受标准护理（包括住院护理）的患者之间未发现统计学上的显著差异。在接受居家临终关怀期间住院的情况因试验而异，这在该分析中表现为高度的统计学显著异质性。有一些证据表明患者对居家临终关怀的满意度有所提高，而关于这种护理形式对护理人员影响的证据很少。
本综述中的证据支持使用临终居家护理项目来增加在家中死亡的患者数量，尽管在接受临终关怀期间住院的患者数量应受到监测。未来的研究还应系统评估临终居家护理对护理人员的影响。
