Shields Linda, Zhou Huaqiong, Pratt Jan, Taylor Marjory, Hunter Judith, Pascoe Elaine
TropicalHealth ResearchUnit forNursing andMidwifery Practice, JamesCookUniversity, Townsville, Australia.
Cochrane Database Syst Rev. 2012 Oct 17;10(10):CD004811. doi: 10.1002/14651858.CD004811.pub3.
This is an update of the Cochrane systematic review of family-centred care published in 2007 (Shields 2007). Family-centred care (FCC) is a widely used model in paediatrics, is thought to be the best way to provide care to children in hospital and is ubiquitous as a way of delivering care. When a child is admitted, the whole family is affected. In giving care, nurses, doctors and others must consider the impact of the child's admission on all family members. However, the effectiveness of family-centred care as a model of care has not been measured systematically.
To assess the effects of family-centred models of care for hospitalised children aged from birth (unlike the previous version of the review, this update excludes premature neonates) to 12 years, when compared to standard models of care, on child, family and health service outcomes.
In the original review, we searched up until 2004. For this update, we searched: the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library, Issue 12 2011); MEDLINE (Ovid SP); EMBASE (Ovid SP); PsycINFO (Ovid SP); CINAHL (EBSCO Host); and Sociological Abstracts (CSA). We did not search three that were included in the original review: Social Work Abstracts, the Australian Medical Index and ERIC. We searched EMBASE in this update only and searched from 2004 onwards. There was no limitation by language. We performed literature searches in May and June 2009 and updated them again in December 2011.
We searched for randomised controlled trials (RCTs) including cluster randomised trials in which family-centred care models are compared with standard models of care for hospitalised children (0 to 12 years, but excluding premature neonates). Studies had to meet criteria for family-centredness. In order to assess the degree of family-centredness, we used a modified rating scale based on a validated instrument, (same instrument used in the initial review), however, we decreased the family-centredness score for inclusion from 80% to 50% in this update. We also changed several other selection criteria in this update: eligible study designs are now limited to randomised controlled trials (RCTs) only; single interventions not reflecting a FCC model of care have been excluded; and the selection criterion whereby studies with inadequate or unclear blinding of outcome assessment were excluded from the review has been removed.
Two review authors undertook searches, and four authors independently assessed studies against the review criteria, while two were assigned to extract data. We contacted study authors for additional information.
Six studies found since 2004 were originally viewed as possible inclusions, but when the family-centred score assessment was tested, only one met the minimum score of family-centredness and was included in this review. This was an unpublished RCT involving 288 children post-tonsillectomy in a care-by-parent unit (CBPU) compared with standard inpatient care.The study used a range of behavioural, economic and physical measures. It showed that children in the CBPU were significantly less likely to receive inadequate care compared with standard inpatient admission, and there were no significant differences for their behavioural outcomes or other physical outcomes. Parents were significantly more satisfied with CBPU care than standard care, assessed both before discharge and at 7 days after discharge. Costs were lower for CPBU care compared with standard inpatient care. No other outcomes were reported. The study was rated as being at low to unclear risk of bias.
AUTHORS' CONCLUSIONS: This update of a review has found limited, moderate-quality evidence that suggests some benefit of a family-centred care intervention for children's clinical care, parental satisfaction, and costs, but this is based on a small dataset and needs confirmation in larger RCTs. There is no evidence of harms. Overall, there continues to be little high-quality quantitative research available about the effects of family-centred care. Further rigorous research on the use of family-centred care as a model for care delivery to children and families in hospitals is needed. This research should implement well-developed family-centred care interventions, ideally in randomised trials. It should investigate diverse participant groups and clinical settings, and should assess a wide range of outcomes for children, parents, staff and health services.
这是对2007年发表的关于以家庭为中心的护理的Cochrane系统评价（希尔兹，2007年）的更新。以家庭为中心的护理（FCC）是儿科中广泛使用的一种模式，被认为是为住院儿童提供护理的最佳方式，并且作为一种护理提供方式随处可见。当孩子住院时，整个家庭都会受到影响。在提供护理时，护士、医生和其他人员必须考虑孩子住院对所有家庭成员的影响。然而，以家庭为中心的护理作为一种护理模式的有效性尚未得到系统评估。
评估与标准护理模式相比，以家庭为中心的护理模式对出生（与该评价的上一版本不同，此次更新排除早产新生儿）至12岁住院儿童的儿童、家庭和卫生服务结局的影响。
在最初的评价中，我们检索到2004年。对于此次更新，我们检索了：Cochrane对照试验中心注册库（CENTRAL，《Cochrane图书馆》，2011年第12期）；MEDLINE（Ovid SP）；EMBASE（Ovid SP）；PsycINFO（Ovid SP）；CINAHL（EBSCO Host）；以及社会学文摘（CSA）。我们未检索最初评价中包含的三个数据库：社会工作文摘、澳大利亚医学索引和教育资源信息中心。此次更新仅检索了EMBASE，且从2004年起开始检索。无语言限制。我们于2009年5月和6月进行了文献检索，并于2011年12月再次更新。
我们检索了随机对照试验（RCT），包括整群随机试验，其中将以家庭为中心的护理模式与住院儿童（0至12岁，但排除早产新生儿）的标准护理模式进行比较。研究必须符合以家庭为中心的标准。为了评估以家庭为中心的程度，我们使用了基于一种经过验证的工具的改良评分量表（与最初评价中使用的工具相同），然而，在此次更新中，我们将纳入的以家庭为中心的评分从80%降至50%。我们在此次更新中还更改了其他几个选择标准：符合条件的研究设计现在仅限于随机对照试验；未反映以家庭为中心的护理模式的单一干预措施已被排除；并且已删除了将结局评估的盲法不充分或不清楚的研究排除在评价之外的选择标准。
两位评价作者进行检索，四位作者根据评价标准独立评估研究，同时分配两位作者提取数据。我们与研究作者联系以获取更多信息。
自2004年以来发现的六项研究最初被视为可能纳入，但在进行以家庭为中心的评分评估时，只有一项达到了以家庭为中心的最低评分并被纳入本评价。这是一项未发表的随机对照试验，涉及288名扁桃体切除术后在家长护理单元（CBPU）的儿童，与标准住院护理进行比较。该研究使用了一系列行为、经济和身体指标。结果显示，与标准住院入院相比，CBPU中的儿童接受不充分护理的可能性显著降低，其行为结局或其他身体结局无显著差异。在出院前和出院后7天进行评估时，家长对CBPU护理的满意度明显高于标准护理。与标准住院护理相比，CBPU护理的成本更低。未报告其他结局。该研究被评为低至不清楚的偏倚风险。
此次评价更新发现了有限的、中等质量的证据，表明以家庭为中心的护理干预在儿童临床护理、家长满意度和成本方面有一些益处，但这基于一个小数据集，需要在更大规模的随机对照试验中得到证实。没有危害的证据。总体而言，关于以家庭为中心的护理的效果，仍然几乎没有高质量的定量研究。需要对在医院中使用以家庭为中心的护理作为向儿童及其家庭提供护理的一种模式进行进一步严格研究。这项研究应实施完善的以家庭为中心的护理干预措施，理想情况下应在随机试验中进行。它应调查不同的参与者群体和临床环境，并应评估儿童、家长、工作人员和卫生服务的广泛结局。
