Maharaj Sandhya, Harding Richard
Caura Palliative Care Unit, Caura Hospital, El Dorado, Trinidad and Tobago.
Department of Palliative Care,Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, London, SE59PJ, UK.
BMC Palliat Care. 2016 Jan 22;15:9. doi: 10.1186/s12904-016-0079-6.
Palliative care provision is expanding in low and middle income countries. Services are developing in the Caribbean in response to the region's ageing population, the significant burden of cancer, non-communicable diseases and HIV/AIDS. Appraisal of the existing evidence on palliative care needs, models of care, interventions and outcomes in the Caribbean is essential to inform emerging practice and future research.
Systematic review and narrative synthesis. Following implementation of a search strategy, titles, abstracts and full texts were screened. Data from nine studies were synthesized. The Qualsyst tools were used to assess the quality of quantitative and qualitative studies. Data were extracted into a common table, and themes were generated from the available peer review evidence using narrative synthesis.
Nine papers were retained for appraisal. Eight papers described palliative care needs in the Caribbean. The needs for analgesia, support for patients, education and training of staff in palliative care and palliative care services were identified in the literature. Models of care for palliative care in the Caribbean were not described in great depth (n = 2 papers) and no intervention studies were found. Outcomes of palliative care such as quality of life, quality of care, and patient's preferred place of care and death were identified from six papers. Quantitative methodology was used in seven of the nine papers in this review. One paper used a mixed methodology design, and one a qualitative approach.
Research from the Caribbean highlights the need for health care policy, training of staff, education, and access to analgesia and palliative care support services in this region. This sparse evidence must be taken into consideration with cultural beliefs and preferences of the Caribbean population in order to achieve improved outcomes for patients, their caregivers and health care professionals. This underscores the importance for more research in the field of palliative care in the Caribbean.
中低收入国家的姑息治疗服务正在不断扩展。加勒比地区的服务也在发展，以应对该地区人口老龄化、癌症、非传染性疾病和艾滋病毒/艾滋病的沉重负担。评估加勒比地区关于姑息治疗需求、护理模式、干预措施和结果的现有证据，对于指导新出现的实践和未来研究至关重要。
系统评价和叙述性综合分析。实施检索策略后，对标题、摘要和全文进行筛选。综合了9项研究的数据。使用Qualsyst工具评估定量和定性研究的质量。数据被提取到一个通用表格中，并使用叙述性综合分析从现有的同行评审证据中生成主题。
保留9篇论文进行评估。8篇论文描述了加勒比地区的姑息治疗需求。文献中确定了对镇痛、患者支持、姑息治疗工作人员的教育和培训以及姑息治疗服务的需求。对加勒比地区姑息治疗的护理模式描述不够深入（n = 2篇论文），未发现干预研究。从6篇论文中确定了姑息治疗的结果，如生活质量、护理质量、患者首选的护理和死亡地点。本综述的9篇论文中有7篇使用了定量方法。1篇论文使用了混合方法设计，1篇使用了定性方法。
来自加勒比地区的研究强调了该地区在医疗保健政策、工作人员培训、教育以及获得镇痛和姑息治疗支持服务方面的需求。必须将这些稀少的证据与加勒比地区人群的文化信仰和偏好相结合，以便为患者、其护理人员和医疗保健专业人员取得更好的结果。这突出了在加勒比地区姑息治疗领域进行更多研究的重要性。
