Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil.
Oncology Graduate Program and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil.
Palliat Support Care. 2021 Jun;19(3):348-354. doi: 10.1017/S1478951520000838.
Although the literature recognizes the participation of patients in medical decisions as an important indicator of quality, there is a lack of consensus regarding the influence of advance directives (ADs) on reducing aggressive measures during end-of-life care involving cancer patients.
A systematic review was conducted to analyze the influence of ADs on reducing aggressive end-of-life care measures for cancer patients.
We searched the Medline, Embase, Web of Science, and Lilacs databases for studies published until March 2018 using the following keywords, without language restrictions: "advance directives," "living wills," "terminal care," "palliative care," "hospice care," and "neoplasms." Article quality was assessed using study quality assessment tools from the Department of Health and Human Services (NHLBI).
A total of 1,489 studies were identified; 7 met the inclusion criteria. The studies were recently published (after 2014, 71.4%). Patients with ADs were more likely to die at the site of choice (n = 3) and received less chemotherapy in the last 30 days (n = 1). ADs had no impact on intensive care unit admission (n = 1) or hospitalization (n = 1). One study found an association between ADs and referral to palliative care, but other did not find the same result.
Of the seven articles found, four demonstrated effects of ADs on the reduction in aggressive measures at the end of life of cancer patients. Heterogeneity regarding study design and results and poor methodological quality are challenges when drawing conclusions.
尽管文献认识到患者参与医疗决策是衡量医疗质量的一个重要指标，但对于预先指示（AD）是否会影响减少癌症患者临终关怀期间的激进治疗措施，目前尚无共识。
系统评价旨在分析 AD 对减少癌症患者临终关怀激进治疗措施的影响。
我们在 Medline、Embase、Web of Science 和 Lilacs 数据库中进行了检索，检索时间截至 2018 年 3 月，使用了以下无语言限制的关键词：“advance directives”“living wills”“terminal care”“palliative care”“hospice care”和“neoplasms”。使用来自美国卫生与公众服务部（NHLBI）的研究质量评估工具评估文章质量。
共确定了 1489 项研究，其中 7 项符合纳入标准。这些研究均为近期发表的（2014 年后，占 71.4%）。有 AD 的患者更有可能在选择的地点死亡（n = 3），并且在最后 30 天内接受的化疗更少（n = 1）。AD 对入住重症监护病房（n = 1）或住院（n = 1）没有影响。一项研究发现 AD 与转介姑息治疗之间存在关联，但其他研究并未得出相同结果。
在这 7 篇文章中，有 4 篇表明 AD 对减少癌症患者临终关怀的激进措施有影响。研究设计和结果的异质性以及较差的方法学质量是得出结论的挑战。
