Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
BMC Med. 2020 Nov 26;18(1):368. doi: 10.1186/s12916-020-01829-x.
Early provision of palliative care, at least 3-4 months before death, can improve patient quality of life and reduce burdensome treatments and financial costs. However, there is wide variation in the duration of palliative care received before death reported across the research literature. This study aims to determine the duration of time from initiation of palliative care to death for adults receiving palliative care across the international literature.
We conducted a systematic review and meta-analysis that was registered with PROSPERO (CRD42018094718). Six databases were searched for articles published between Jan 1, 2013, and Dec 31, 2018: MEDLINE, Embase, CINAHL, Global Health, Web of Science and The Cochrane Library, as well undertaking citation list searches. Following PRISMA guidelines, articles were screened using inclusion (any study design reporting duration from initiation to death in adults palliative care services) and exclusion (paediatric/non-English language studies, trials influencing the timing of palliative care) criteria. Quality appraisal was completed using Hawker's criteria and the main outcome was the duration of palliative care (median/mean days from initiation to death).
One hundred sixty-nine studies from 23 countries were included, involving 11,996,479 patients. Prior to death, the median duration from initiation of palliative care to death was 18.9 days (IQR 0.1), weighted by the number of participants. Significant differences between duration were found by disease type (15 days for cancer vs 6 days for non-cancer conditions), service type (19 days for specialist palliative care unit, 20 days for community/home care, and 6 days for general hospital ward) and development index of countries (18.91 days for very high development vs 34 days for all other levels of development). Forty-three per cent of studies were rated as 'good' quality. Limitations include a preponderance of data from high-income countries, with unclear implications for low- and middle-income countries.
Duration of palliative care is much shorter than the 3-4 months of input by a multidisciplinary team necessary in order for the full benefits of palliative care to be realised. Furthermore, the findings highlight inequity in access across patient, service and country characteristics. We welcome more consistent terminology and methodology in the assessment of duration of palliative care from all countries, alongside increased reporting from less-developed settings, to inform benchmarking, service evaluation and quality improvement.
至少在死亡前 3-4 个月提供姑息治疗，可以提高患者的生活质量，减少负担过重的治疗和财务成本。然而，在研究文献中，报告的死亡前接受姑息治疗的持续时间存在很大差异。本研究旨在确定国际文献中接受姑息治疗的成年人从开始姑息治疗到死亡的时间。
我们进行了系统评价和荟萃分析，该分析已在 PROSPERO（CRD42018094718）上注册。为了寻找 2013 年 1 月 1 日至 2018 年 12 月 31 日期间发表的文章，我们检索了六个数据库：MEDLINE、Embase、CINAHL、全球卫生、Web of Science 和 Cochrane Library，同时还进行了引文列表检索。根据 PRISMA 指南，使用纳入标准（任何报告成年人姑息治疗服务中从开始到死亡的持续时间的研究设计）和排除标准（儿科/非英语语言研究、影响姑息治疗时间的试验）筛选文章。使用 Hawker 的标准进行质量评估，主要结局是姑息治疗的持续时间（从开始到死亡的中位数/平均值天数）。
来自 23 个国家的 169 项研究纳入了 11996479 名患者。在死亡之前，从姑息治疗开始到死亡的中位持续时间为 18.9 天（IQR 0.1），按参与者人数加权。不同疾病类型（癌症为 15 天，非癌症为 6 天）、服务类型（专科姑息治疗单位为 19 天，社区/家庭护理为 20 天，综合医院病房为 6 天）和国家发展指数（极高发展水平为 18.91 天，所有其他发展水平为 34 天）之间存在显著差异。43%的研究被评为“良好”质量。限制因素包括来自高收入国家的数据占主导地位，对低收入和中等收入国家的影响尚不清楚。
姑息治疗的持续时间远远短于多学科团队输入的 3-4 个月，而这是实现姑息治疗全部益处所必需的。此外，这些发现突出了在患者、服务和国家特征方面获得姑息治疗的机会不平等。我们欢迎所有国家在评估姑息治疗持续时间方面使用更一致的术语和方法，并增加来自欠发达国家的报告，以便为基准测试、服务评估和质量改进提供信息。
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