Clark Joseph, Gardiner Clare, Barnes Amy
Department of Public Health, University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK.
University of Sheffield, School of Nursing, Sheffield, UK.
BMJ Support Palliat Care. 2018 Mar;8(1):7-18. doi: 10.1136/bmjspcare-2015-001008. Epub 2016 Aug 2.
An increasing amount of health policy is formulated at global level. At this global level, palliative care has attracted support primarily from normative institutions (WHO), not funding agencies. To attract greater global attention from policymakers, it has been argued that an international approach to research is required. However, the extent to which an international approach is being undertaken is unknown.
To systematically identify and thematically synthesise all international palliative care research, defined as research involving two or more countries, or focused on the global level.
Five bibliographic databases (CINAHL, Cochrane Library, ASSIA, Web of Knowledge, Psychinfo) were searched for journal articles relevant to international and global palliative care and end-of-life care. Data were extracted using a piloted extraction form and findings were synthesised.
184 studies were included, published across 75 different academic journals. Research emanates from and focuses on all world regions and there is increasing focus on the global level. Thematically, there is a high focus on Evaluation (n=53) and views of Stakeholders (n=38). The review revealed a predominantly observational research approach and few interventional studies were identified.
International palliative care research is a relatively new, but growing field. However, many gaps in the evidence base remain and palliative care research continues to take place outside broader discourses of international development. The relative absence of interventional research demonstrating the effectiveness and cost-effectiveness of palliative care risks limiting the tools with which advocates can engage with international policymakers on this topic.
越来越多的卫生政策在全球层面制定。在这个全球层面，姑息治疗主要得到了规范性机构（世界卫生组织）的支持，而非资助机构的支持。为了吸引政策制定者更多的全球关注，有人认为需要采取一种国际研究方法。然而，目前尚不清楚这种国际方法的实施程度。
系统识别并主题性综合所有国际姑息治疗研究，定义为涉及两个或更多国家或聚焦于全球层面的研究。
检索了五个文献数据库（护理学与健康领域数据库、考克兰图书馆、应用社会科学索引与摘要数据库、科学网、心理学文摘数据库），以查找与国际和全球姑息治疗及临终关怀相关的期刊文章。使用预先试验的提取表格提取数据并综合研究结果。
纳入了184项研究，这些研究发表在75种不同的学术期刊上。研究源自并聚焦于世界所有地区，且对全球层面的关注日益增加。从主题上看，高度关注评估（n = 53）和利益相关者的观点（n = 38）。该综述显示主要采用观察性研究方法，仅识别出少数干预性研究。
国际姑息治疗研究是一个相对较新但不断发展的领域。然而，证据基础仍存在许多空白，并且姑息治疗研究仍在国际发展的更广泛讨论之外进行。相对缺乏证明姑息治疗有效性和成本效益的干预性研究，这有可能限制倡导者就该主题与国际政策制定者接触时所使用的工具。
