Department of Physiotherapy, Western Health, Sunshine Hospital, St Albans, Melbourne, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Crit Care Med. 2018 Sep;46(9):1522-1531. doi: 10.1097/CCM.0000000000003293.
Identifying solutions to improve recovery after critical illness is a pressing problem. We systematically evaluated studies of peer support as a potential intervention to improve recovery in critical care populations and synthesized elements important to peer support model design.
A systematic search of Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, PsychINFO, and Excertpa Medica Database was undertaken May 2017. Prospective Register of Systematic Reviews identification number: CRD42017070174.
Two independent reviewers assessed titles and abstracts against study eligibility criteria. Studies were included where 1) patients and families had experienced critical illness and 2) patients and families had participated in a peer support intervention. Discrepancies were resolved by consensus and a third independent reviewer adjudicated as necessary.
Two independent reviewers assessed study quality with the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool, and data were synthesized according to the Preferred Reporting Items for Systematic Reviews guidelines and interventions summarized using the Template for Intervention Description and Replication Checklist.
Two-thousand nine-hundred thirty-two studies were screened. Eight were included, comprising 192 family members and 92 patients including adults (with cardiac surgery, acute myocardial infarction, trauma), pediatrics, and neonates. The most common peer support model of the eight studies was an in-person, facilitated group for families that occurred during the patients' ICU admission. Peer support reduced psychologic morbidity and improved social support and self-efficacy in two studies; in both cases, peer support was via an individual peer-to-peer model. In the remaining studies, it was difficult to determine the outcomes of peer support as the reporting and quality of studies was low.
Peer support appeared to reduce psychologic morbidity and increase social support. The evidence for peer support in critically ill populations is limited. There is a need for well-designed and rigorously reported research into this complex intervention.
寻找改善危重病后恢复的方法是一个紧迫的问题。我们系统地评估了同伴支持作为改善重症监护人群恢复的潜在干预措施的研究，并综合了同伴支持模式设计的重要因素。
2017 年 5 月，我们对医学文献分析和检索系统在线、护理和联合健康文献累积索引、心理信息和 Excertpa Medica 数据库进行了系统搜索。前瞻性系统评价注册识别号：CRD42017070174。
两名独立评审员根据研究资格标准评估标题和摘要。如果 1）患者和家属经历过危重病，2）患者和家属参与了同伴支持干预，则纳入研究。有分歧时通过协商解决，必要时由第三名独立评审员裁决。
两名独立评审员使用纽卡斯尔-渥太华量表和 Cochrane 偏倚风险工具评估研究质量，并根据系统评价和干预措施的首选报告项目指南进行数据综合，使用干预描述和复制清单模板进行总结。
筛选了 2932 项研究。其中 8 项研究包括 192 名家属和 92 名患者，包括成年人（心脏手术、急性心肌梗死、创伤）、儿科和新生儿。这 8 项研究中最常见的同伴支持模式是在患者入住 ICU 期间为家属提供的面对面、有针对性的小组支持。两项研究表明，同伴支持可降低心理发病率并提高社会支持和自我效能感；在这两种情况下，同伴支持都是通过个体对个体的模式进行的。在其余研究中，由于报告和研究质量较低，很难确定同伴支持的结果。
同伴支持似乎可以降低心理发病率并增加社会支持。在危重病患者中，同伴支持的证据有限。需要对这一复杂干预措施进行精心设计和严格报告的研究。
