对有严重精神疾病的人使用的姑息治疗工具和干预措施的系统评价。
A systematic review of palliative care tools and interventions for people with severe mental illness.
机构信息
Nivel. Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands.
Medical Library, VU University Amsterdam, Amsterdam, the Netherlands.
出版信息
BMC Psychiatry. 2019 Apr 3;19(1):106. doi: 10.1186/s12888-019-2078-7.
BACKGROUND
Increasing attention to palliative care for the general population has led to the development of various evidence-based or consensus-based tools and interventions. However, specific tools and interventions are needed for people with severe mental illness (SMI) who have a life-threatening illness. The aim of this systematic review is to summarize the scientific evidence on tools and interventions in palliative care for this group.
METHODS
Systematic searches were done in the PubMed, Cochrane Library, CINAHL, PsycINFO and Embase databases, supplemented by reference tracking, searches on the internet with free text terms, and consultations with experts to identify relevant literature. Empirical studies with qualitative, quantitative or mixed-methods designs concerning tools and interventions for use in palliative care for people with SMI were included. Methodological quality was assessed using a critical appraisal instrument for heterogeneous study designs. Stepwise study selection and the assessment of methodological quality were done independently by two review authors.
RESULTS
Four studies were included, reporting on a total of two tools and one multi-component intervention. One study concerned a tool to identify the palliative phase in patients with SMI. This tool appeared to be usable only in people with SMI with a cancer diagnosis. Furthermore, two related studies focused on a tool to involve people with SMI in discussions about medical decisions at the end of life. This tool was assessed as feasible and usable in the target group. One other study concerned the Dutch national Care Standard for palliative care, including a multi-component intervention. The Palliative Care Standard also appeared to be feasible and usable in a mental healthcare setting, but required further tailoring to suit this specific setting. None of the included studies investigated the effects of the tools and interventions on quality of life or quality of care.
CONCLUSIONS
Studies of palliative care tools and interventions for people with SMI are scarce. The existent tools and intervention need further development and should be tailored to the care needs and settings of these people. Further research is needed on the feasibility, usability and effects of tools and interventions for palliative care for people with SMI.
背景
越来越多的人关注普通人群的姑息治疗，导致了各种基于证据或共识的工具和干预措施的发展。然而，对于患有危及生命疾病的严重精神疾病（SMI）患者，需要特定的工具和干预措施。本系统评价的目的是总结关于这一群体姑息治疗工具和干预措施的科学证据。
方法
在 PubMed、Cochrane Library、CINAHL、PsycINFO 和 Embase 数据库中进行系统搜索，补充使用自由文本词在互联网上搜索和咨询专家，以确定相关文献。纳入关于用于 SMI 患者姑息治疗的工具和干预措施的定性、定量或混合方法设计的实证研究。使用针对异质研究设计的批判性评价工具评估方法学质量。两位综述作者独立进行逐步研究选择和方法学质量评估。
结果
共纳入 4 项研究，报告了总共 2 种工具和 1 种多组分干预措施。一项研究涉及一种用于识别 SMI 患者姑息阶段的工具。该工具似乎仅可用于患有 SMI 且患有癌症的患者。此外，两项相关研究侧重于一种用于使 SMI 患者参与生命末期医疗决策讨论的工具。该工具在目标人群中被评估为可行且可用。另一项研究涉及荷兰姑息护理国家护理标准，包括多组分干预措施。姑息护理标准在精神卫生保健环境中似乎也是可行和可用的，但需要进一步定制以适应这一特定环境。纳入的研究均未调查工具和干预措施对生活质量或护理质量的影响。
结论
针对 SMI 患者姑息治疗工具和干预措施的研究很少。现有的工具和干预措施需要进一步发展，并应根据这些患者的护理需求和环境进行调整。需要进一步研究姑息治疗工具和干预措施对 SMI 患者的可行性、可用性和效果。
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