Schmidt Ellie B, Blum David, Domeisen Benedetti Franzisca, Schlögl Mathias, Strasser Florian
Clinic for Medical Oncology & Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland.
BMJ Support Palliat Care. 2023 Oct;13(e1):e1-e9. doi: 10.1136/bmjspcare-2020-002495. Epub 2020 Nov 11.
The unmet needs of patients with advanced disease are indicative of the patient centredness of healthcare. By tracking unmet needs in clinical practice, palliative interventions are aligned with patient priorities, and clinicians receive support in intervention delivery decisions for patients with overlapping, complex needs.
Identify tools used in everyday clinical practice for the purpose of identifying and addressing unmet healthcare needs for patients with advanced disease.
We conducted PubMed and Cumulative Index of Nursing and Allied Health Literature searches to include studies published between 1 January 2008 and 21 April 2020. Three concepts were used in constructing a search statement: (1) patient need, (2) validated instrument and (3) clinical practice. 2313 citations were reviewed according to predefined eligibility, exclusion and inclusion criteria. Data were collected from 17 tools in order to understand how instruments assess unmet need, who is involved in tool completion, the psychometric validation conducted, the tool's relationship to delivering defined palliative interventions, and the number of palliative care domains covered.
The majority of the 17 tools assessed unmet healthcare needs and had been validated. However, most did not link directly to clinical intervention, nor did they facilitate interaction between clinicians and patients to ensure a patient-reported view of unmet needs. Half of the tools reviewed covered ≤3 dimensions of palliative care. Of the 17 tools evaluated, 4 were compared in depth, but all were determined to be insufficient for the specific clinical applications sought in this research.
A new, validated tool is needed to track unmet healthcare needs and guide interventions for patients with advanced disease.
晚期疾病患者未满足的需求体现了以患者为中心的医疗服务。通过在临床实践中追踪未满足的需求，姑息治疗干预措施与患者的优先事项保持一致，并且临床医生在为需求重叠且复杂的患者做出干预决策时能得到支持。
确定日常临床实践中用于识别和解决晚期疾病患者未满足的医疗需求的工具。
我们在PubMed和护理及联合健康文献累积索引中进行了检索，纳入2008年1月1日至2020年4月21日发表的研究。在构建检索语句时使用了三个概念：（1）患者需求，（2）经过验证的工具，（3）临床实践。根据预先定义的合格、排除和纳入标准对2313条引文进行了审查。从17种工具中收集数据，以了解这些工具如何评估未满足的需求、谁参与工具的填写、进行的心理测量学验证、工具与提供明确的姑息治疗干预措施的关系以及所涵盖的姑息治疗领域的数量。
17种工具中的大多数评估了未满足的医疗需求并且已经经过验证。然而，大多数工具并未直接与临床干预相关联，也没有促进临床医生与患者之间的互动以确保获得患者报告的未满足需求的观点。所审查的工具中有一半涵盖的姑息治疗维度≤3个。在评估的17种工具中，对4种进行了深入比较，但所有这些工具都被确定不足以满足本研究中寻求的特定临床应用。
需要一种新的、经过验证的工具来追踪晚期疾病患者未满足的医疗需求并指导干预措施。
