ElMokhallalati Yousuf, Bradley Stephen H, Chapman Emma, Ziegler Lucy, Murtagh Fliss Em, Johnson Miriam J, Bennett Michael I
Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK.
Academic Unit of Primary Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK.
Palliat Med. 2020 Sep;34(8):989-1005. doi: 10.1177/0269216320929552. Epub 2020 Jun 7.
Despite increasing evidence of the benefits of early access to palliative care, many patients do not receive palliative care in a timely manner. A systematic approach in primary care can facilitate earlier identification of patients with potential palliative care needs and prompt further assessment.
To identify existing screening tools for identification of patients with advanced progressive diseases who are likely to have palliative care needs in primary healthcare and evaluate their accuracy.
Systematic review (PROSPERO registration number CRD42019111568).
Cochrane, MEDLINE, Embase and CINAHL were searched from inception to March 2019.
From 4,127 unique articles screened, 25 reported the use or development of 10 screening tools. Most tools use prediction of death and/or deterioration as a proxy for the identification of people with potential palliative care needs. The tools are based on a wide range of general and disease-specific indicators. The accuracy of five tools was assessed in eight studies; these tools differed significantly in their ability to identify patients with potential palliative care needs with sensitivity ranging from 3% to 94% and specificity ranging from 26% to 99%.
The ability of current screening tools to identify patients with advanced progressive diseases who are likely to have palliative care needs in primary care is limited. Further research is needed to identify standardised screening processes that are based not only on predicting mortality and deterioration but also on anticipating the palliative care needs and predicting the rate and course of functional decline. This would prompt a comprehensive assessment to identify and meet their needs on time.
尽管越来越多的证据表明早期获得姑息治疗有益，但许多患者并未及时接受姑息治疗。初级保健中的系统方法有助于更早识别有潜在姑息治疗需求的患者，并促使进一步评估。
识别用于在初级医疗保健中识别可能有姑息治疗需求的晚期进行性疾病患者的现有筛查工具，并评估其准确性。
系统评价（PROSPERO注册号CRD42019111568）。
检索Cochrane、MEDLINE、Embase和CINAHL自创建至2019年3月的文献。
在筛选的4127篇独特文章中，25篇报告了10种筛查工具的使用或开发情况。大多数工具使用死亡和/或病情恶化预测作为识别有潜在姑息治疗需求者的替代指标。这些工具基于广泛的一般和疾病特异性指标。八项研究评估了五种工具的准确性；这些工具在识别有潜在姑息治疗需求患者的能力方面存在显著差异，敏感性范围为3%至94%，特异性范围为26%至99%。
当前筛查工具在初级保健中识别可能有姑息治疗需求的晚期进行性疾病患者的能力有限。需要进一步研究以确定标准化的筛查流程，该流程不仅基于预测死亡率和病情恶化，还基于预测姑息治疗需求以及预测功能衰退的速度和进程。这将促使进行全面评估，以便及时识别并满足他们的需求。
