Quigley Denise D, McCleskey Sara G
RAND Corporation, Santa Monica, CA, USA.
8783UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, Los Angeles, CA, USA.
Am J Hosp Palliat Care. 2021 Jan;38(1):84-93. doi: 10.1177/1049909120931468. Epub 2020 Jun 19.
End-of-life care is increasing as the US population ages. Approaches to providing high-quality end-of-life care vary across setting, diseases, and populations. Several data collection tools measure patient and/or caregiver care experiences at end of life and can be used for quality improvement. Previous reviews examined palliative care improvements or available measures but none explicitly on improving care experiences. We reviewed literature on improving patient and/or caregiver end-of-life care experiences.
We searched U.S. English-language peer-reviewed and grey literature after 2000 on adult end-of-life care experiences. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for quantitative studies, Enhancing Transparency in Reporting the Synthesis of Qualitative Research approach for qualitative studies, and Assessment of Multiple Systematic Reviews tool for the literature reviews.
Palliative and hospice care.
Full-text abstraction of 84 articles, identifying 16 articles.
Patient and/or caregiver end-of-life care experiences (captured through administrative data or direct report).
Articles examined palliative care experiences across settings; none studied hospice care experiences. Patients and/or caregivers assessed overall care experiences, clinician-staff interactions, provider communication, respect and trust, timeliness of care, spiritual support, caregiver knowledge of care plans, or bereavement support. Efforts aimed at improving end-of-life care experiences are limited and show mixed results.
Literature on improving patient and/or caregiver end-of-life care experiences is emerging and focused on palliative care experiences. Evidence on improving hospice care experiences is lacking. Research on strategies for improving end-of-life care experiences should go beyond overall care experiences to include specific aspects of palliative and hospice care experiences.
随着美国人口老龄化，临终关怀服务日益增加。提供高质量临终关怀的方式因环境、疾病和人群而异。有几种数据收集工具可衡量患者和/或护理人员在临终时的护理体验，并可用于质量改进。以往的综述研究了姑息治疗的改善情况或可用的衡量指标，但没有一项明确针对改善护理体验。我们对有关改善患者和/或护理人员临终护理体验的文献进行了综述。
我们检索了2000年以后美国英文同行评审文献和灰色文献，内容涉及成人临终护理体验。我们遵循系统评价和Meta分析的首选报告项目指南进行定量研究，采用提高定性研究综合报告透明度的方法进行定性研究，并使用多系统评价评估工具进行文献综述。
姑息治疗和临终关怀。
对84篇文章进行全文摘要，筛选出16篇文章。
患者和/或护理人员的临终护理体验（通过行政数据或直接报告获取）。
文章研究了不同环境下的姑息治疗体验；没有一项研究临终关怀体验。患者和/或护理人员评估了总体护理体验、临床医护人员互动、提供者沟通、尊重与信任、护理及时性、精神支持、护理人员对护理计划的了解或丧亲之痛支持。旨在改善临终护理体验的努力有限，结果参差不齐。
关于改善患者和/或护理人员临终护理体验的文献正在涌现，且主要集中在姑息治疗体验方面。缺乏关于改善临终关怀体验的证据。改善临终护理体验策略的研究应超越总体护理体验，纳入姑息治疗和临终关怀体验的具体方面。
