Chan Raymond J, Webster Joan
Cancer Care Services, Royal Brisbane and Women's Hospital, Level 2, Building 34,, Butterfield Street, Brisbane, QLD, Australia, 4029.
Cochrane Database Syst Rev. 2013 Nov 18(11):CD008006. doi: 10.1002/14651858.CD008006.pub3.
This is an updated version of a Cochrane review first published in Issue 1, 2010 of The Cochrane Library. In many clinical areas, integrated care pathways are utilised as structured multidisciplinary care plans that detail essential steps in caring for patients with specific clinical problems. In particular, care pathways for the dying have been developed as a model to improve care of patients who are in the last days of life. The care pathways were designed with an aim of ensuring that the most appropriate management occurs at the most appropriate time and that it is provided by the most appropriate health professional. There have been sustained concerns about the safety of implementing end-of-life care pathways, particularly in the UK. Therefore, there is a significant need for clinicians and policy makers to be informed about the effects of end-of-life care pathways with a systematic review.
To assess the effects of end-of-life care pathways, compared with usual care (no pathway) or with care guided by another end-of-life care pathway across all healthcare settings (e.g. hospitals, residential aged care facilities, community).In particular, we aimed to assess the effects on symptom severity and quality of life of people who are dying; those related to the care such as families, carers and health professionals; or a combination of these.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 6, 2013), MEDLINE, EMBASE, PsycINFO, CINAHL, review articles and reference lists of relevant articles. We conducted the original search in September 2009, and the updated search in June 2013.
All randomised controlled trials (RCTs), quasi-randomised trial or high-quality controlled before-and-after studies comparing use versus non-use of an end-of-life care pathway in caring for the dying.
Two review authors assessed the results of the searches against the predetermined criteria for inclusion.
The original review identified 920 titles. The updated search found 2042 potentially relevant titles (including the original 920), but no additional studies met criteria for inclusion in the review update.
AUTHORS' CONCLUSIONS: With sustained concerns about the safety of the pathway implementation and the lack of available evidence on important patient and relative outcomes, recommendations for the use of end-of-life pathways in caring for the dying cannot be made. Since the last version of this review, no new studies met criteria for inclusion in the review update. With recently documented concerns related to the potential adverse effects associated with Liverpool Care Pathway (the most commonly used end-of-life care pathway), we do not recommend decision making based on indirect or low-quality evidence. All health services using end-of-life care pathways are encouraged to have their use of the pathway, to date, independently audited. Any subsequent use should be based on carefully documented evaluations. Large RCTs or other well-designed controlled studies are urgently required for the evaluation of the use of end-of-life care pathways in caring for dying people in various clinical settings. In future studies, outcome measures should include benefits or harms concerning the outcomes of interest in this review in relation to patients, families, carers and health professionals.
这是一篇Cochrane系统评价的更新版本，该评价首次发表于《Cochrane图书馆》2010年第1期。在许多临床领域，综合护理路径被用作结构化的多学科护理计划，详细说明了护理特定临床问题患者的基本步骤。特别是，临终护理路径已被开发为一种模式，以改善处于生命末期患者的护理。护理路径的设计目的是确保在最合适的时间进行最恰当的管理，并由最合适的卫生专业人员提供护理。人们一直对实施临终护理路径的安全性存在担忧，尤其是在英国。因此，迫切需要通过系统评价让临床医生和政策制定者了解临终护理路径的效果。
评估临终护理路径与常规护理（无路径）或与其他临终护理路径指导的护理相比，在所有医疗环境（如医院、老年护理机构、社区）中的效果。特别是，我们旨在评估对临终患者症状严重程度和生活质量的影响；与护理相关的影响，如对家属、护理人员和卫生专业人员的影响；或这些影响的综合结果。
我们检索了Cochrane对照试验中心注册库（CENTRAL）（2013年第6期）、MEDLINE、EMBASE、PsycINFO、CINAHL、综述文章以及相关文章的参考文献列表。我们于2009年9月进行了首次检索，并于2013年6月进行了更新检索。
所有比较在临终护理中使用与不使用临终护理路径的随机对照试验（RCT）、半随机试验或高质量的前后对照研究。
两名综述作者根据预定的纳入标准评估检索结果。
最初的综述识别出920个标题。更新检索发现2042个潜在相关标题（包括最初的920个），但没有其他研究符合纳入综述更新的标准。
由于一直有人担心路径实施的安全性，且缺乏关于重要患者和亲属结局的可用证据，因此无法就临终护理路径在临终患者护理中的使用提出建议。自本综述的上一版本以来，没有新的研究符合纳入综述更新的标准。鉴于最近有记录表明与最常用的临终护理路径——利物浦护理路径相关的潜在不良影响，我们不建议基于间接或低质量证据进行决策。鼓励所有使用临终护理路径的卫生服务机构对其迄今为止对路径的使用情况进行独立审核。任何后续使用都应基于详细记录的评估。迫切需要进行大型RCT或其他精心设计的对照研究，以评估临终护理路径在各种临床环境中对临终患者护理的使用情况。在未来的研究中，结局指标应包括与本综述中感兴趣的结局相关的对患者、家属、护理人员和卫生专业人员的益处或危害。
