Tavares Nuno, Jarrett Nikki, Hunt Katherine, Wilkinson Tom
Portsmouth Hospitals NHS Trust, Portsmouth, UK.
NIHR CLAHRC Wessex, Southampton, UK.
ERJ Open Res. 2017 Apr 27;3(2). doi: 10.1183/23120541.00068-2016. eCollection 2017 Apr.
Chronic obstructive pulmonary disease (COPD) is a chronic life-limiting disorder characterised by persistent airflow obstruction and progressive breathlessness. Discussions/conversations between patients and clinicians ensure palliative care plans are grounded in patients' preferences. This systematic review aimed to explore what is known about palliative care conversations between clinicians and COPD patients. A comprehensive search of all major healthcare-related databases and websites was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were quality assessed, employing widely used quality-assessment tools, with only papers scoring moderate-to-high quality included. All relevant data were extracted. A narrative synthesis was used to analyse, process and present the final data. The findings indicated that the frequency and quality of palliative care conversations is generally poor. Patients and physicians identified many barriers and important topics were not discussed. Patients and clinicians reported tension between remaining hopeful and the reality of the patients' condition. When discussions did happen, they often occurred at an advanced stage of illness and in respiratory wards and intensive care units. In conclusion, current care practices do not facilitate satisfactory conversations about palliative care between COPD patients and clinicians. This impacts upon the fulfilment of patients' preferences at the end of life.
慢性阻塞性肺疾病（COPD）是一种慢性的、限制生命的疾病，其特征为持续的气流阻塞和进行性呼吸困难。患者与临床医生之间的讨论/对话可确保姑息治疗计划基于患者的偏好。本系统评价旨在探讨关于临床医生与COPD患者之间姑息治疗对话的已知情况。按照系统评价和Meta分析的首选报告项目（PRISMA）指南，对所有主要的医疗相关数据库和网站进行了全面检索。采用广泛使用的质量评估工具对研究进行质量评估，仅纳入质量得分中等至高质量的论文。提取了所有相关数据。采用叙述性综合分析来分析、处理和呈现最终数据。研究结果表明，姑息治疗对话的频率和质量普遍较差。患者和医生识别出许多障碍，重要话题未得到讨论。患者和临床医生报告了在保持希望与患者病情现实之间的矛盾。当进行讨论时，往往发生在疾病晚期以及呼吸病房和重症监护病房。总之，当前的护理实践不利于COPD患者与临床医生之间就姑息治疗进行令人满意的对话。这影响了患者在生命末期偏好的实现。
