1 Doctoral Programme GROW 'Gerontological Research on Well-Being', University of Cologne, Cologne, Germany.
2 Department of Palliative Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.
Palliat Med. 2018 Apr;32(4):815-837. doi: 10.1177/0269216317748889. Epub 2018 Jan 11.
At the end of life, anxious attitudes concerning the dying process are common in patients in Palliative Care. Measurement tools can identify vulnerabilities, resources and the need for subsequent treatment to relieve suffering and support well-being.
To systematically review available tools measuring attitudes towards dying, their operationalization, the method of measurement and the methodological quality including generalizability to different contexts.
Systematic review according to the PRISMA Statement. Methodological quality of tools assessed by standardized review criteria.
MEDLINE, PsycINFO, PsyndexTests and the Health and Psychosocial Instruments were searched from their inception to April 2017.
A total of 94 identified studies reported the development and/or validation of 44 tools. Of these, 37 were questionnaires and 7 alternative measurement methods (e.g. projective measures). In 34 of 37 questionnaires, the emotional evaluation (e.g. anxiety) towards dying is measured. Dying is operationalized in general items ( n = 20), in several specific aspects of dying ( n = 34) and as dying of others ( n = 14). Methodological quality of tools was reported inconsistently. Nine tools reported good internal consistency. Of 37 tools, 4 were validated in a clinical sample (e.g. terminal cancer; Huntington disease), indicating questionable generalizability to clinical contexts for most tools.
Many tools exist to measure attitudes towards the dying process using different endpoints. This overview can serve as decision framework on which tool to apply in which contexts. For clinical application, only few tools were available. Further validation of existing tools and potential alternative methods in various populations is needed.
在生命末期，临终关怀患者中常见对临终过程感到焦虑的态度。测量工具可以识别脆弱性、资源以及后续缓解痛苦和支持幸福感的治疗需求。
系统回顾评估临终态度的可用测量工具，包括其操作化、测量方法以及方法学质量，包括在不同环境下的通用性。
根据 PRISMA 声明进行系统回顾。使用标准化的评价标准评估工具的方法学质量。
从建立至 2017 年 4 月，在 MEDLINE、PsycINFO、PsyndexTests 和 Health and Psychosocial Instruments 中进行检索。
共识别出 94 项研究，报道了 44 种工具的开发和/或验证。其中，37 项为问卷，7 项为替代测量方法（例如，投射测量）。在 37 个问卷中的 34 个中，测量对临终的情绪评估（例如焦虑）。临终通常在一般项目中进行操作化（ n = 20），在临终的几个具体方面进行操作化（ n = 34），并作为他人的临终进行操作化（ n = 14）。工具的方法学质量报告不一致。9 种工具报告了良好的内部一致性。在 37 种工具中，有 4 种在临床样本中进行了验证（例如，晚期癌症；亨廷顿病），这表明大多数工具在临床环境中的通用性存在疑问。
有许多工具可用于使用不同的终点测量临终过程的态度。这一综述可作为在哪些环境下应用哪种工具的决策框架。对于临床应用，只有少数工具可用。需要进一步在不同人群中验证现有工具和潜在的替代方法。
