School of Nursing and Midwifery, National University of Ireland, Galway, Ireland.
James Hardiman Library, National University of Ireland, Galway, Ireland.
Eur J Cancer Care (Engl). 2020 Nov;29(6). doi: 10.1111/ecc.13316. Epub 2020 Sep 9.
Patients with haematological malignancies may not be receiving appropriate referrals to palliative care and continuing to have treatments in the end stages of their disease. This systematic review of qualitative research aimed to synthesise healthcare professionals' (HCPs) views and experiences of palliative care for adult patients with a haematologic malignancy.
A systematic search strategy was undertaken across eight databases. Thomas and Harden's approach to thematic analysis guided synthesis on the seventeen included studies. GRADE-GRADEQual guided assessment of confidence in the synthesised findings.
Three analytic themes were identified: (a) "Maybe we can pull another 'rabbit out of the hat'," represents doctors' therapeutic optimism, (b) "To tell or not to tell?" explores doctors' decision-making around introducing palliative care, and (c) "Hospice, home or hospital?" describes HCPs concerns about challenges faced by haematology patients at end of life in terms of transfusion support and risk of catastrophic bleeds.
Haematologists value the importance of integrated palliative care but prefer the term "supportive care." Early integration of supportive care alongside active curative treatment should be the model of choice in haematology settings in order to achieve the best outcomes and improved quality of life.
患有血液系统恶性肿瘤的患者可能无法获得适当的姑息治疗转诊，并且在疾病的终末期仍继续接受治疗。本系统评价旨在综合医疗保健专业人员（HCP）对患有血液系统恶性肿瘤的成年患者姑息治疗的观点和经验。
在八个数据库中进行了系统搜索策略。托马斯和哈登的主题分析方法指导了十七项纳入研究的综合分析。GRADE-GRADEQual 指导对综合研究结果的信心进行评估。
确定了三个分析主题：（a）“也许我们可以再从帽子里掏出一只兔子”，代表医生的治疗乐观主义；（b）“告诉还是不告诉？”探讨了医生在引入姑息治疗方面的决策；（c）“临终关怀、家庭还是医院？”描述了 HCP 对血液学患者在生命末期面临的输血支持和灾难性出血风险方面的担忧。
血液学家重视姑息治疗的重要性，但更喜欢“支持性护理”一词。在血液学环境中，应优先选择早期整合支持性护理和积极的治疗方法，以实现最佳结果和提高生活质量。
