Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Continuing Care, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Bruyère Research Institute, Ottawa, Ontario, Canada.
J Pain Symptom Manage. 2019 Mar;57(3):661-681.e12. doi: 10.1016/j.jpainsymman.2018.12.002. Epub 2018 Dec 12.
Based on the clinical care pathway of delirium in palliative care (PC), a published analytic framework (AF) formulated research questions in key domains and recommended a scoping review to identify evidence gaps.
To produce a literature map for key domains of the published AF: screening, prognosis and diagnosis, management, and the health-related outcomes.
A standard scoping review framework was used by an interdisciplinary study team of nurse- and physician-delirium researchers, an information specialist, and review methodologists to conduct the review. Knowledge user engagement provided context in refining 19 AF questions. A peer-reviewed search strategy identified citations in Medline, PsycINFO, Embase, and CINAHL databases between 1980 and 2018. Two reviewers independently screened records for inclusion using explicit study eligibility criteria for the population, design, delirium diagnosis, and investigational intent.
Of 104 studies reporting empirical data and meeting eligibility criteria, most were conducted in patients with cancer (73.1%) and in inpatient PC units (52%). The most frequent study design was a one or more group, nonrandomized trial or cohort (67.3%). Evidence gaps were identified: delirium risk prediction; comparative effectiveness and harms of prevention, variability in delirium management across PC settings, advanced directive and substitute decision-maker input, and transition of care location; and estimating delirium reversibility. Future rigorous primary studies are required to address these gaps and preliminary concerns regarding the quality of extant literature.
Substantial evidence gaps exist, providing opportunities for future research regarding the assessment, prognosis, and management of delirium in PC settings.
基于姑息治疗（PC）中谵妄的临床护理路径，一个已发表的分析框架（AF）在关键领域提出了研究问题，并建议进行范围综述以确定证据差距。
为已发表 AF 的关键领域生成文献图谱：筛查、预后和诊断、管理以及与健康相关的结局。
一个由护士和医生谵妄研究人员、信息专家和综述方法学家组成的跨学科研究团队使用标准的范围综述框架来进行综述。知识使用者的参与为精炼 19 个 AF 问题提供了背景信息。经过同行评审的搜索策略在 1980 年至 2018 年间在 Medline、PsycINFO、Embase 和 CINAHL 数据库中确定了引文。两名审查员使用明确的研究纳入标准独立筛选记录，这些标准适用于人群、设计、谵妄诊断和研究意图。
在报告实证数据并符合纳入标准的 104 项研究中，大多数研究的对象是癌症患者（73.1%）和住院 PC 病房（52%）。最常见的研究设计是一个或多个组、非随机试验或队列（67.3%）。确定了证据差距：谵妄风险预测；预防的比较效果和危害、PC 环境中谵妄管理的变异性、预先指示和替代决策人的投入以及护理地点的转移；以及估计谵妄的可逆性。需要进行未来的严格的初步研究来解决这些差距和现有文献质量的初步关注。
姑息治疗环境中存在大量的证据差距，为评估、预后和管理谵妄提供了未来研究的机会。
