1 ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain.
2 IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Spain.
J Palliat Med. 2019 May;22(5):580-590. doi: 10.1089/jpm.2018.0510. Epub 2019 Jan 7.
Indicators assessing national-level palliative care (PC) development used for cross-national comparison depict progress on this field. There is current interest on its inclusion in global monitoring frameworks. Identify and conceptualize those most frequently used for international PC development reporting. Systematic review. PubMed, CINAHL, Google Scholar, and Google targeting national-level development indicators used for cross-national comparison. Additional search requesting experts' suggestions on key studies and "snow-balling" on reference section of all included studies. Identified indicators were listed and categorized in dimensions: services, use of medicines, policy, and education. Fifty-four studies were included. Development has been evaluated using 480 different formulations of 165 indicators, 38 were highly reported. Thirty-two fell into proposed dimensions, 11 for use of medicines, 9 for policy, 7 for services, and 5 for education. Six into complementary dimensions: research, professional activity, and international cooperation. Six were the most frequently used indicators: number of PC services per population (40 reports), existence of PC national plan, strategy, or program (25), existence of palliative medicine specialization (22), availability and allocation of funds for PC (13), medical schools, including PC, in undergraduate curricula (13), and total use of opioids-morphine equivalents (11). There is a clear pattern for national-level PC development evaluation repeatedly using a small number of indicators. Indicators addressing generalistic provision, integration into health systems, and specific fields such as pediatric lack. This study invites international discussion on a global consensus on PC-development assessment.
用于跨国比较的评估国家层面缓和医疗（PC）发展的指标描绘了该领域的进展。目前人们对将其纳入全球监测框架感兴趣。确定并概念化那些用于国际 PC 发展报告的最常用指标。系统评价。PubMed、CINAHL、Google Scholar 和 Google 针对用于跨国比较的国家层面发展指标进行搜索。另外还要求专家就关键研究提出建议，并对所有纳入研究的参考文献进行“滚雪球”搜索。确定的指标按服务、药物使用、政策和教育等维度列出和分类。纳入了 54 项研究。使用 165 个指标的 480 种不同表述形式评估了发展情况，其中 38 个指标被高度报道。32 个指标归入提出的维度，11 个用于药物使用，9 个用于政策，7 个用于服务，5 个用于教育。6 个归入补充维度：研究、专业活动和国际合作。6 个是最常用的指标：每人口的 PC 服务数量（40 项报告）、存在 PC 国家计划、战略或方案（25 项）、存在姑息医学专业（22 项）、PC 资金的可用性和分配（13 项）、包括 PC 在内的本科课程中的医学院（13 项）和总阿片类药物-吗啡当量使用量（11 项）。 国家层面的 PC 发展评估反复使用少数指标的情况非常明显。指标在一般性供应、纳入卫生系统以及儿科等特定领域的覆盖存在不足。本研究邀请国际社会就 PC 发展评估的全球共识展开讨论。
