Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Geriatric Clinic, Helsinki Hospital, Helsinki, Finland.
Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland.
J Am Med Dir Assoc. 2021 Feb;22(2):268-278. doi: 10.1016/j.jamda.2020.09.011. Epub 2020 Oct 26.
The aim was to review evidence from all randomized controlled trials (RCTs) using palliative care education or staff training as an intervention to improve nursing home residents' quality of life (QOL) or quality of dying (QOD) or to reduce burdensome hospitalizations.
A systematic review with a narrative summary.
Residents in nursing homes and other long-term care facilities.
We searched MEDLINE, CINAHL, PsycINFO, the Cochrane Library, Scopus, and Google Scholar, references of known articles, previous reviews, and recent volumes of key journals. RCTs were included in the review. Methodologic quality was assessed.
The search yielded 932 articles after removing the duplicates. Of them, 16 cluster RCTs fulfilled inclusion criteria for analysis. There was a great variety in the interventions with respect to learning methods, intensity, complexity, and length of staff training. Most interventions featured other elements besides staff training. In the 6 high-quality trials, only 1 showed a reduction in hospitalizations, whereas among 6 moderate-quality trials 2 suggested a reduction in hospitalizations. None of the high-quality trials showed effects on residents' QOL or QOD. Staff reported an improved QOD in 1 moderate-quality trial.
Irrespective of the means of staff training, there were surprisingly few effects of education on residents' QOL, QOD, or burdensome hospitalizations. Further studies are needed to explore the reasons behind these findings.
本研究旨在回顾所有采用姑息治疗教育或员工培训作为干预措施的随机对照试验（RCT）的证据，以提高养老院居民的生活质量（QOL）或临终质量（QOD），或减少不必要的住院治疗。
系统评价，附有叙述性总结。
养老院和其他长期护理机构的居民。
我们检索了 MEDLINE、CINAHL、PsycINFO、Cochrane 图书馆、Scopus 和 Google Scholar、已知文章的参考文献、先前的综述以及主要期刊的最新卷。本综述纳入了 RCT。评估了方法学质量。
在去除重复项后，搜索共产生了 932 篇文章。其中，16 项集群 RCT 符合分析纳入标准。干预措施在学习方法、强度、复杂性和员工培训长度方面存在很大差异。大多数干预措施除了员工培训外，还具有其他要素。在 6 项高质量试验中，只有 1 项显示减少了住院治疗，而在 6 项中等质量试验中，有 2 项表明减少了住院治疗。没有一项高质量试验显示对居民的 QOL 或 QOD 有影响。在 1 项中等质量试验中，员工报告 QOD 有所改善。
无论采用何种员工培训方式，教育对居民的 QOL、QOD 或不必要的住院治疗几乎没有影响。需要进一步研究以探讨这些发现背后的原因。
