Hui David, Nooruddin Zohra, Didwaniya Neha, Dev Rony, De La Cruz Maxine, Kim Sun Hyun, Kwon Jung Hye, Hutchins Ronald, Liem Christiana, Bruera Eduardo
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
J Pain Symptom Manage. 2014 Jan;47(1):77-89. doi: 10.1016/j.jpainsymman.2013.02.021. Epub 2013 Jun 21.
The terms "actively dying," "end of life," "terminally ill," "terminal care," and "transition of care" are commonly used but rarely and inconsistently defined.
We conducted a systematic review to examine the concepts and definitions for these terms.
We searched MEDLINE, PsycINFO, Embase, and CINAHL for published peer-reviewed articles from 1948 to 2012 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. We also searched 10 dictionaries, four palliative care textbooks, and 13 organization Web sites, including the U.S. Federal Code.
One of 16, three of 134, three of 44, two of 93, and four of 17 articles defined or conceptualized actively dying, end of life, terminally ill, terminal care, and transition of care, respectively. Actively dying was defined as "hours or days of survival." We identified two key defining features for end of life, terminally ill, and terminal care: life-limiting disease with irreversible decline and expected survival in terms of months or less. Transition of care was discussed in relation to changes in 1) place of care (e.g., hospital to home), 2) level of professions providing the care (e.g., acute care to hospice), and 3) goals of care (e.g., curative to palliative). Definitions for these five terms were rarely found in dictionaries, textbooks, and organizational Web sites. However, when available, the definitions were generally consistent with the concepts discussed previously.
We identified unifying concepts for five commonly used terms in palliative care and developed a preliminary conceptual framework toward building standardized definitions.
“濒死”“生命末期”“绝症”“临终关怀”以及“照护过渡”等术语虽常用，但定义少见且不一致。
我们进行了一项系统综述，以研究这些术语的概念和定义。
我们检索了MEDLINE、PsycINFO、Embase和CINAHL数据库，查找1948年至2012年发表的经过同行评审的文章，这些文章对这些术语进行了概念化、定义或研究。两名研究人员独立审查每篇文献是否纳入，然后在可行时提取概念/定义。我们还检索了10本词典、4本姑息治疗教科书以及13个组织的网站，包括美国联邦法规。
16篇文章中有1篇、134篇文章中有3篇、44篇文章中有3篇、93篇文章中有2篇以及17篇文章中有4篇分别对濒死、生命末期、绝症、临终关怀和照护过渡进行了定义或概念化。濒死被定义为“存活数小时或数天”。我们确定了生命末期、绝症和临终关怀的两个关键定义特征：伴有不可逆转衰退的危及生命的疾病以及预期存活时间为数月或更短。照护过渡是围绕以下方面的变化进行讨论的：1）照护地点（例如，从医院到家中），2）提供照护的专业人员级别（例如，从急性护理到临终关怀），以及3）照护目标（例如，从治愈到姑息）。在词典、教科书和组织网站中很少能找到这五个术语的定义。然而，当有定义时，这些定义通常与之前讨论的概念一致。
我们确定了姑息治疗中五个常用术语的统一概念，并制定了一个初步的概念框架，以构建标准化定义。
