College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Age Ageing. 2021 Feb 26;50(2):534-545. doi: 10.1093/ageing/afaa229.
recent data show that there is limited evidence and guidance regarding the best practices for the integration of palliative care (PC) and end-of-life (EOL) post-stroke. The purpose of this meta-synthesis is to understand the PC/EOL experiences after a stroke.
a meta-synthesis was conducted to answer the following research question-What are post-stroke PC/EOL experiences from the perspectives of patients, families and healthcare professionals (HCPs)? This approach was completed through two main phases-a systematic search and appraisal of the literature and reciprocal translation with interpretive triangulation of the extracted data. Databases searched were MEDLINE, EMBASE, PsycINFO, Joanna Briggs Institute and CINAHL databases (from their inception to April 2020). After data were extracted, a qualitative exploratory design was used to evaluate the PC/EOL in post-stroke experiences.
the search identified 696 studies. A total of 14 studies were included in this meta-synthesis as they satisfied our eligibility criteria. Uncertainty post-stroke was the overarching main theme that emerged across post-stroke PC/EOL experiences. Within this theme of uncertainty, opportunities to decrease uncertainty emerged from two interdependent themes-presence of cohesive communication and shared dynamic decision process for both families and HCPs.
to mitigate the degree of uncertainty post-stroke, HCPs should be present, provide clear direct communication and incorporate the value-based goals of care within their medical treatment plan. These findings suggest that future research is needed to focus on how PC approaches can be integrated into stroke care programmes.
最近的数据表明，关于将姑息治疗（PC）和终末期（EOL）纳入脑卒中后最佳实践的证据和指导有限。本荟萃分析的目的是了解脑卒中后 PC/EOL 的体验。
进行荟萃分析以回答以下研究问题-从患者、家庭和医疗保健专业人员（HCP）的角度来看，脑卒中后 PC/EOL 的体验是什么？通过两个主要阶段完成了这种方法-对文献进行系统搜索和评估，以及对提取数据进行解释性三角分析的相互翻译。搜索的数据库包括 MEDLINE、EMBASE、PsycINFO、Joanna Briggs 研究所和 CINAHL 数据库（从其成立到 2020 年 4 月）。在提取数据后，使用定性探索性设计评估脑卒中后 PC/EOL 的体验。
搜索确定了 696 项研究。共有 14 项研究被纳入本荟萃分析，因为它们符合我们的入选标准。脑卒中后出现的不确定性是贯穿脑卒中后 PC/EOL 体验的首要主题。在这个不确定性主题中，有两个相互依存的主题出现了减少不确定性的机会-家庭和 HCP 之间存在凝聚力的沟通和共同的动态决策过程。
为了减轻脑卒中后的不确定性程度，HCP 应该在场，提供明确的直接沟通，并将基于价值的护理目标纳入他们的治疗计划中。这些发现表明，需要进一步研究如何将 PC 方法纳入脑卒中护理计划中。
