School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia.
BMC Palliat Care. 2018 Jul 23;17(1):96. doi: 10.1186/s12904-018-0346-9.
This systematic review aimed to identify the unmet care needs and their associated variables in patients with advanced cancer and informal caregivers, alongside summarizing the tools used for needs assessment.
Ten electronic databases were searched systematically from inception of each database to December 2016 to determine eligible studies. Studies that considered the unmet care needs of either adult patients with advanced cancer or informal caregivers, regardless of the study design, were included. The Mixed Methods Appraisal Tool was utilized for quality appraisal of the included studies. Content analysis was used to identify unmet needs, and descriptive analysis was adopted to synthesize other outcomes.
Fifty studies were included, and their methodological quality was generally robust. The prevalence of unmet needs varied across studies. Twelve unmet need domains were identified in patients with advanced cancer, and seven among informal caregivers. The three most commonly reported domains for patients were psychological, physical, and healthcare service and information. The most prominent unmet items of these domains were emotional support (10.1-84.4%), fatigue (18-76.3%), and "being informed about benefits and side-effects of treatment" (4-66.7%). The most commonly identified unmet needs for informal caregivers were information needs, including illness and treatment information (26-100%) and care-related information (21-100%). Unmet needs of patients with advanced cancer were associated with their physical symptoms, anxiety, and quality of life. The most commonly used instruments for needs assessment among patients with advanced cancer were the Supportive Care Needs Survey (N = 8) and Problems and Needs in Palliative Care questionnaire (N = 5). The majority of the included studies investigated unmet needs from the perspectives of either patients or caregivers with a cross-sectional study design using single time-point assessments. Moreover, significant heterogeneity, including differences in study contexts, assessment methods, instruments for measurement, need classifications, and reporting methods, were identified across studies.
Both advanced cancer patients and informal caregivers reported a wide range of context-bound unmet needs. Examining their unmet needs on the basis of viewing patients and their informal caregivers as a whole unit will be highly optimal. Unmet care needs should be comprehensively evaluated from the perspectives of all stakeholders and interpreted by using rigorously designed mixed methods research and longitudinal studies within a given context.
本系统评价旨在确定晚期癌症患者及其非专业照护者的未满足的护理需求及其相关变量，并总结用于需求评估的工具。
系统检索了从每个数据库建立到 2016 年 12 月的 10 个电子数据库，以确定合格的研究。纳入了考虑成年晚期癌症患者或非专业照护者未满足的护理需求的研究，无论研究设计如何。采用混合方法评估工具对纳入的研究进行质量评估。内容分析用于确定未满足的需求，描述性分析用于综合其他结果。
共纳入 50 项研究，其方法学质量总体上较为可靠。研究中未满足需求的发生率存在差异。在晚期癌症患者中确定了 12 个未满足需求领域，在非专业照护者中确定了 7 个领域。患者中报告最多的三个未满足需求领域是心理、生理和医疗保健服务及信息。这些领域中最常见的未满足需求项目是情感支持（10.1-84.4%）、疲劳（18-76.3%）和“了解治疗的益处和副作用”（4-66.7%）。非专业照护者最常见的未满足需求是信息需求，包括疾病和治疗信息（26-100%）和护理相关信息（21-100%）。晚期癌症患者的未满足需求与其身体症状、焦虑和生活质量有关。最常用于评估晚期癌症患者需求的工具是支持性护理需求调查（N=8）和姑息治疗问题和需求问卷（N=5）。大多数纳入的研究都是采用横断面研究设计，仅在一个时间点进行评估，从患者或照护者的角度调查未满足的需求。此外，研究之间存在显著的异质性，包括研究背景、评估方法、测量工具、需求分类和报告方法的差异。
晚期癌症患者和非专业照护者均报告存在广泛的特定情境下的未满足需求。从将患者及其非专业照护者视为一个整体单元的角度来全面评估他们的未满足需求将是非常理想的。应从所有利益相关者的角度全面评估未满足的护理需求，并在特定背景下使用严格设计的混合方法研究和纵向研究进行解释。
