1 Faculty of Medicine, Imperial College London, London, UK.
2 Imperial College Business School, London, UK.
Palliat Med. 2018 Feb;32(2):314-328. doi: 10.1177/0269216317713427. Epub 2017 Jun 12.
In many countries, achieving a home death represents a successful outcome from both a patient welfare and commissioning viewpoint. Significant variation exists in the proportion of home deaths achieved internationally, with many countries unable to meet the wishes of a large number of patients. This review builds on previous literature investigating factors influencing home death, synthesising qualitative research to supplement evidence that quantitative research in this field may have been unable to reach.
To identify and understand the barriers and facilitators influencing death at home.
Meta-ethnography.
The review adhered to the PRISMA guidelines. A systematic literature search was conducted using five databases: PubMed, EMBASE, Ovid, CINAHL and PsycINFO. Databases were searched from 2006 to 2016. Empirical, UK-based qualitative studies were included for analysis.
A total of 38 articles were included for analysis. Seven overarching barriers were identified: lack of knowledge, skills and support among informal carers and healthcare professionals; informal carer and family burden; recognising death; inadequacy of processes such as advance care planning and discharge; as well as inherent patient difficulties, either due to the condition or social circumstances. Four overarching facilitators were observed: support for patients and healthcare professionals, skilled staff, coordination and effective communication.
Future policies and clinical practice should develop measures to empower informal carers as well as emphasise earlier commencement of advance care planning. Best practice discharge should be recommended in addition to addressing remaining inequity to enable non-cancer patients greater access to palliative care services.
在许多国家，从患者福利和委托角度来看，实现在家中死亡代表着一个成功的结果。国际上在家中死亡的比例存在显著差异，许多国家无法满足大量患者的愿望。本综述建立在前瞻性文献调查影响在家中死亡因素的基础上，对定性研究进行综合，以补充该领域定量研究可能无法达到的证据。
确定并了解影响在家中死亡的障碍和促进因素。
元人种学。
本综述遵循 PRISMA 指南。使用五个数据库（PubMed、EMBASE、Ovid、CINAHL 和 PsycINFO）进行了系统文献检索：PubMed、EMBASE、Ovid、CINAHL 和 PsycINFO。数据库从 2006 年到 2016 年进行了搜索。纳入了以英国为基础的实证性定性研究进行分析。
共纳入 38 篇文章进行分析。确定了 7 个总体障碍：非正式照顾者和医疗保健专业人员缺乏知识、技能和支持；非正式照顾者和家庭负担；识别死亡；诸如预先护理计划和出院等过程的不足；以及患者固有的困难，无论是由于病情还是社会环境所致。观察到 4 个总体促进因素：为患者和医疗保健专业人员提供支持、有技能的工作人员、协调和有效的沟通。
未来的政策和临床实践应制定措施，增强非正式照顾者的能力，并强调提前进行预先护理计划。除了解决剩余的不平等问题，以允许更多的非癌症患者获得姑息治疗服务外，还应推荐最佳的出院实践。
