Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science (LSE), London, United Kingdom.
Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science (LSE), London, United Kingdom.
J Pain Symptom Manage. 2018 Jan;55(1):132-150.e1. doi: 10.1016/j.jpainsymman.2017.04.009. Epub 2017 Aug 5.
End-of-life care for people with dementia can be poor, involving emergency hospital admissions, burdensome treatments of uncertain value, and undertreatment of pain and other symptoms. Advance care planning (ACP) is identified, in England and elsewhere, as a means of improving end-of-life outcomes for people with dementia and their carers.
To systematically and critically review empirical evidence concerning the effectiveness of ACP in improving end-of-life outcomes for people with dementia and their carers.
Systematic searches of academic databases (CINAHL Plus with full text, PsycINFO, SocINDEX with full text, and PubMed) were conducted to identify research studies, published between January 2000-January 2017 and involving statistical methods, in which ACP is an intervention or independent variable, and in which end-of-life outcomes for people with dementia and/or their carers are reported.
A total of 18 relevant studies were identified. Most found ACP to be associated with some improved end-of-life outcomes. Studies were predominantly, but not exclusively, from the U.S. and care home-based. Type of ACP and outcome measures varied. Quality was assessed using National Institute of Health and Care Excellence quality appraisal checklists. Over half of the studies were of moderate to high quality. Three were randomized controlled trials, two of which were low quality.
There is a need for more high-quality outcome studies, particularly using randomized designs to control for confounding. These need to be underpinned by sufficient development work and process evaluation to clarify the appropriateness of outcome measures, explore implementation issues and identify "active elements."
痴呆患者的临终关怀可能很差，包括紧急住院、治疗负担沉重但价值不确定以及疼痛和其他症状的治疗不足。在英国和其他地方，预先护理计划（ACP）被确定为改善痴呆患者及其照顾者的临终结局的一种手段。
系统地、批判性地回顾有关 ACP 改善痴呆患者及其照顾者临终结局的有效性的实证证据。
系统地搜索学术数据库（CINAHL Plus 全文、PsycINFO、SocINDEX 全文和 PubMed），以确定研究研究，发表于 2000 年 1 月至 2017 年 1 月之间，使用统计方法，其中 ACP 是一种干预或自变量，并且报告了痴呆患者和/或其照顾者的临终结局。
确定了 18 项相关研究。大多数研究发现 ACP 与一些改善的临终结局相关。研究主要但不限于来自美国和疗养院。ACP 的类型和结果测量方法多种多样。使用国家卫生与保健卓越质量评估清单评估了质量。超过一半的研究质量为中等至高质量。其中三项为随机对照试验，其中两项质量较低。
需要更多高质量的结局研究，特别是使用随机设计来控制混杂因素。这些研究需要有足够的开发工作和过程评估来澄清结果测量的适当性，探讨实施问题并确定“有效元素”。
