Brighton Lisa Jane, Miller Sophie, Farquhar Morag, Booth Sara, Yi Deokhee, Gao Wei, Bajwah Sabrina, Man William D-C, Higginson Irene J, Maddocks Matthew
Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
School of Health Sciences, University of East Anglia, Norwich, UK.
Thorax. 2019 Mar;74(3):270-281. doi: 10.1136/thoraxjnl-2018-211589. Epub 2018 Nov 29.
Breathlessness is a common, distressing symptom in people with advanced disease and a marker of deterioration. Holistic services that draw on integrated palliative care have been developed for this group. This systematic review aimed to examine the outcomes, experiences and therapeutic components of these services.
Systematic review searching nine databases to June 2017 for experimental, qualitative and observational studies. Eligibility and quality were independently assessed by two authors. Data on service models, health and cost outcomes were synthesised, using meta-analyses as indicated. Data on recipient experiences were synthesised thematically and integrated at the level of interpretation and reporting.
From 3239 records identified, 37 articles were included representing 18 different services. Most services enrolled people with thoracic cancer, involved palliative care staff and comprised 4-6 contacts over 4-6 weeks. Commonly used interventions included breathing techniques, psychological support and relaxation techniques. Meta-analyses demonstrated reductions in Numeric Rating Scale distress due to breathlessness (n=324; mean difference (MD) -2.30, 95% CI -4.43 to -0.16, p=0.03) and Hospital Anxiety and Depression Scale (HADS) depression scores (n=408, MD -1.67, 95% CI -2.52 to -0.81, p<0.001) favouring the intervention. Statistically non-significant effects were observed for Chronic Respiratory Questionnaire (CRQ) mastery (n=259, MD 0.23, 95% CI -0.10 to 0.55, p=0.17) and HADS anxiety scores (n=552, MD -1.59, 95% CI -3.22 to 0.05, p=0.06). Patients and carers valued tailored education, self-management interventions and expert staff providing person-centred, dignified care. However, there was no observable effect on health status or quality of life, and mixed evidence around physical function.
Holistic services for chronic breathlessness can reduce distress in patients with advanced disease and may improve psychological outcomes of anxiety and depression. Therapeutic components of these services should be shared and integrated into clinical practice.
CRD42017057508.
呼吸困难是晚期疾病患者常见的痛苦症状，也是病情恶化的一个指标。针对这一群体，已开发出借鉴综合姑息治疗的整体服务。本系统评价旨在研究这些服务的效果、患者体验及治疗要素。
系统评价检索了截至2017年6月的九个数据库，以查找实验性、定性和观察性研究。两名作者独立评估研究的纳入资格和质量。综合服务模式、健康和成本结果的数据，按要求进行荟萃分析。对接受者体验的数据进行主题综合，并在解释和报告层面进行整合。
从识别出的3239条记录中，纳入了37篇文章，代表18种不同的服务。大多数服务纳入了肺癌患者，涉及姑息治疗人员，在4至6周内进行4至6次接触。常用干预措施包括呼吸技巧、心理支持和放松技巧。荟萃分析表明，因呼吸困难导致的数字评分量表痛苦程度降低（n = 324；平均差(MD) -2.30，95%置信区间 -4.43至 -0.16，p = 0.03），医院焦虑抑郁量表(HADS)抑郁评分降低（n = 408，MD -1.67，95%置信区间 -2.52至 -0.81，p < 0.001），支持干预措施。慢性呼吸问卷(CRQ)掌握度（n = 259，MD 0.23，95%置信区间 -0.10至0.55，p = 0.17）和HADS焦虑评分（n = 552，MD -1.59，95%置信区间 -3.22至0.05，p = 0.06）观察到统计学上无显著影响。患者和护理人员重视量身定制的教育、自我管理干预措施以及提供以人为本、有尊严护理的专业人员。然而，对健康状况或生活质量没有明显影响，关于身体功能的证据不一。
针对慢性呼吸困难的整体服务可减轻晚期疾病患者的痛苦，并可能改善焦虑和抑郁的心理结果。这些服务的治疗要素应予以分享并整合到临床实践中。
CRD42017057508。
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