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缓和医疗从急性护理向基于社区的护理的过渡-系统评价。

Palliative Care Transitions From Acute Care to Community-Based Care-A Systematic Review.

机构信息

Temmy Latner Centre for Palliative Care and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.

Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.

出版信息

J Pain Symptom Manage. 2019 Oct;58(4):721-734.e1. doi: 10.1016/j.jpainsymman.2019.06.005. Epub 2019 Jun 13.

Abstract

CONTEXT

Although the literature on transitions from hospital to the community is extensive, little is known about this experience within the context of palliative care (PC).

OBJECTIVE

We conducted a systematic review to investigate the impact of receiving palliative care in hospital on the transition from hospital to the community.

METHODS

We systematically searched MEDLINE, Embase, ProQuest, and CINAHL from 1995 until April 10, 2018, and extracted relevant references. Eligible articles were published in English, included adult patients receiving PC as inpatients, and explored transitions from hospital to the community.

RESULTS

A total of 1514 studies were identified and eight met inclusion criteria. Studies were published recently (>2012; n = 7, 88%). Specialist PC interventions were delivered by multidisciplinary care teams as part of inpatient PC triggers, discharge planning programs, and transitional care programs. Common outcomes reported with significant findings consisted of length of stay (n = 5), discharge support (n = 5), and hospital readmissions (n = 6) for those who received inpatient PC. Most studies were at high risk of bias.

CONCLUSION

Heterogeneity of study designs, outcomes, findings, and poor methodological quality renders it challenging to draw conclusions regarding PC's impact on the transition from hospital to home. Further research should use standardized outcomes with randomized controlled trial and/or propensity matched cohort designs.

摘要

背景

尽管有关从医院到社区的过渡的文献很多,但在姑息治疗(PC)的背景下,人们对这方面的经验知之甚少。

目的

我们进行了一项系统评价,以调查在医院接受姑息治疗对从医院到社区过渡的影响。

方法

我们系统地检索了 MEDLINE、Embase、ProQuest 和 CINAHL,检索时间从 1995 年至 2018 年 4 月 10 日,并提取了相关参考文献。符合条件的文章以英文发表,纳入了接受住院姑息治疗的成年患者,并探讨了从医院到社区的过渡。

结果

共确定了 1514 项研究,其中 8 项符合纳入标准。这些研究发表于最近(>2012;n=7,88%)。专科姑息治疗干预措施由多学科护理团队提供,作为住院姑息治疗触发因素、出院计划方案和过渡性护理方案的一部分。有显著意义的常见报告结果包括接受住院姑息治疗的患者的住院时间(n=5)、出院支持(n=5)和住院再入院率(n=6)。大多数研究存在高偏倚风险。

结论

研究设计、结果、发现的异质性以及较差的方法学质量使得难以就姑息治疗对从医院到家庭的过渡的影响得出结论。进一步的研究应使用标准化的结果,采用随机对照试验和/或倾向匹配队列设计。

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