Walshe Catherine, Dodd Steven, Hill Matt, Ockenden Nick, Payne Sheila, Preston Nancy, Perez Algorta Guillermo
International Observatory on End of Life Care, Division of Health Research, Lancaster University, Bailrigg, Lancaster, LA1 4YW, UK.
Institute for Volunteering Research, NCVO, Society Building, 8 All Saints Street, London, N1 9RL, UK.
BMC Med. 2016 Dec 9;14(1):203. doi: 10.1186/s12916-016-0746-8.
Clinical care alone at the end of life is unlikely to meet all needs. Volunteers are a key resource, acceptable to patients, but there is no evidence on care outcomes. This study aimed to determine whether support from a social action volunteer service is better than usual care at improving quality of life for adults in the last year of life.
A pragmatic, multi-centre wait-list controlled trial, with participants randomly allocated to receive the volunteer support intervention either immediately or after a 4 week wait. Trained volunteers provided tailored face-to-face support including befriending, practical support and signposting to services, primarily provided within the home, typically for 2-3 hours per week. The primary outcome was rate of change of quality of life at 4 weeks (WHO QOL BREF, a general, culturally sensitive measure). Secondary outcomes included rate of change of quality of life at 8 weeks and Loneliness (De Jong Gierveld Loneliness Scale), social support (mMOS-SS), and reported use of health and social care services at 4 and 8 weeks.
In total, 196 adults (61% (n = 109) female; mean age 72 years) were included in the study. No significant difference was found in main or secondary outcomes at 4 weeks. Rate of change of quality of life showed trends in favour of the intervention (physical quality of life domain: b = 3.98, CI, -0.38 to 8.34; psychological domain: b = 2.59, CI, -2.24 to 7.43; environmental domain: b = 3, CI, -4.13 to 4.91). Adjusted analyses to control for hours of volunteer input found significantly less decrease in physical quality of life in the intervention group (slope (b) 4.43, CI, 0.10 to 8.76). While the intervention also favoured the rate of change of emotional (b = -0.08; CI, -0.52 to 0.35) and social loneliness (b = -0.20; CI, -0.58 to 0.18), social support (b = 0.13; CI, -0.13 to 0.39), and reported use of health and social care professionals (b = 0.16; CI, -0.22 to 0.55), these were not statistically significant. No adverse events were reported.
Clinicians can confidently refer to volunteer services at the end of life. Future research should focus on 'dose' to maximise likely impact.
The trial was prospectively registered. ISRCTN Registry: ISRCTN12929812 , registered 20 May 2015.
临终时仅靠临床护理不太可能满足所有需求。志愿者是一种关键资源，患者能够接受，但尚无关于护理效果的证据。本研究旨在确定社会行动志愿服务的支持在改善成年人生命最后一年的生活质量方面是否优于常规护理。
一项实用的多中心等待名单对照试验，参与者被随机分配立即接受志愿者支持干预或等待4周后接受。经过培训的志愿者提供量身定制的面对面支持，包括建立友谊、实际支持以及指向服务的指引，主要在家庭环境中提供，通常每周2 - 3小时。主要结局是4周时生活质量的变化率（世界卫生组织生活质量简表，一种通用的、对文化敏感的测量方法）。次要结局包括8周时生活质量的变化率、孤独感（德容·吉尔维尔德孤独量表）、社会支持（mMOS - SS）以及4周和8周时报告的健康和社会护理服务使用情况。
本研究共纳入196名成年人（女性占61%（n = 109）；平均年龄72岁）。4周时主要或次要结局均未发现显著差异。生活质量变化率显示出有利于干预的趋势（生理生活质量领域：b = 3.98，置信区间，-0.38至8.34；心理领域：b = 2.59，置信区间，-2.24至7.43；环境领域：b = 3，置信区间，-4.13至4.91）。控制志愿者投入时长的调整分析发现，干预组生理生活质量的下降显著更少（斜率（b）4.43，置信区间，0.10至8.76）。虽然干预也有利于情绪（b = -0.08；置信区间，-0.52至0.35）和社交孤独感（b = -0.20；置信区间，-0.58至0.18）的变化率、社会支持（b = 0.13；置信区间，-0.13至0.39）以及报告的健康和社会护理专业人员的使用情况（b = 0.16；置信区间，-0.22至0.55），但这些均无统计学意义。未报告不良事件。
临床医生可以放心地在临终时推荐志愿服务。未来的研究应关注“剂量”以最大化可能的影响。
该试验进行了前瞻性注册。国际标准随机对照试验编号：ISRCTN12929812，于2015年5月20日注册。
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