Luckett Tim, Phillips Jane, Agar Meera, Virdun Claudia, Green Anna, Davidson Patricia M
Improving Palliative Care through Clinical Trials (ImPaCCT), Sydney, NSW, Australia.
BMC Health Serv Res. 2014 Mar 26;14:136. doi: 10.1186/1472-6963-14-136.
Population ageing, changes to the profiles of life-limiting illnesses and evolving societal attitudes prompt a critical evaluation of models of palliative care. We set out to identify evidence-based models of palliative care to inform policy reform in Australia.
A rapid review of electronic databases and the grey literature was undertaken over an eight week period in April-June 2012. We included policy documents and comparative studies from countries within the Organisation for Economic Co-operation and Development (OECD) published in English since 2001. Meta-analysis was planned where >1 study met criteria; otherwise, synthesis was narrative using methods described by Popay et al. (2006).
Of 1,959 peer-reviewed articles, 23 reported systematic reviews, 9 additional RCTs and 34 non-randomised comparative studies. Variation in the content of models, contexts in which these were implemented and lack of detailed reporting meant that elements of models constituted a more meaningful unit of analysis than models themselves. Case management was the element most consistently reported in models for which comparative studies provided evidence for effectiveness. Essential attributes of population-based palliative care models identified by policy and addressed by more than one element were communication and coordination between providers (including primary care), skill enhancement, and capacity to respond rapidly to individuals' changing needs and preferences over time.
Models of palliative care should integrate specialist expertise with primary and community care services and enable transitions across settings, including residential aged care. The increasing complexity of care needs, services, interventions and contextual drivers warrants future research aimed at elucidating the interactions between different components and the roles played by patient, provider and health system factors. The findings of this review are limited by its rapid methodology and focus on model elements relevant to Australia's health system.
人口老龄化、危及生命疾病谱的变化以及社会态度的演变促使人们对姑息治疗模式进行批判性评估。我们旨在确定基于证据的姑息治疗模式，为澳大利亚的政策改革提供参考。
于2012年4月至6月的八周时间内，对电子数据库和灰色文献进行了快速回顾。我们纳入了自2001年以来以英文发表的经济合作与发展组织（OECD）国家的政策文件和比较研究。若有超过1项研究符合标准，则计划进行荟萃分析；否则，采用Popay等人（2006年）描述的方法进行叙述性综合分析。
在1959篇同行评审文章中，23篇报告了系统评价，9项额外的随机对照试验和34项非随机比较研究。模式内容、实施背景的差异以及缺乏详细报告意味着，模式要素比模式本身构成了更有意义的分析单位。病例管理是比较研究提供有效性证据的模式中最常报告的要素。政策确定的、由多个要素解决的基于人群的姑息治疗模式的基本属性包括提供者之间（包括初级保健）的沟通与协调、技能提升以及随着时间推移快速响应个体不断变化的需求和偏好的能力。
姑息治疗模式应将专科专业知识与初级和社区护理服务相结合，并实现跨环境的过渡，包括老年护理机构。护理需求、服务干预措施和背景驱动因素日益复杂，这使得未来有必要开展研究，以阐明不同组成部分之间的相互作用以及患者、提供者和卫生系统因素所起的作用。本综述的结果受其快速方法学以及对与澳大利亚卫生系统相关的模式要素的关注所限。
