Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Surgery, University of California, San Diego, California, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Pain Symptom Manage. 2021 Sep;62(3):545-558. doi: 10.1016/j.jpainsymman.2021.01.122. Epub 2021 Jan 30.
Defining high quality palliative care in seriously ill surgical patients is essential to provide patient-centered surgical care. Quality indicators specifically for seriously ill surgical patients are necessary in order to integrate palliative care into existing surgical quality improvement programs.
To identify existing quality indicators that measure palliative care delivery in seriously ill surgical patients, characterize their development, and assess their methodological quality.
A PRISMA-guided systematic review included studies that reported on the development process and characteristics of palliative care quality indicators and guidelines in adult surgical patients. Relevant measures were categorized into the previously defined National Consensus Project domains of palliative care and the Donabedian quality framework, and assessed for methodological quality.
There were 263 unique measures identified from 26 studies, of which 70% were process measures. Indicators addressing Care of the Patient Near the End of Life (31.5%) and Physical Aspects of Care (20.8%) were the most common. Indicators addressing Spiritual (2.6%) and Cultural Aspects of Care (1.2%) were the least common. Methodological quality varied widely across studies. Although most studies defined a purpose for the indicators and used scientific evidence, many studies lacked input from target populations and few had discussed the practical application of indicators.
This review was a key step that informed efforts to develop quality indicators for seriously ill surgical patients. Few indicators addressed non-physical aspects of suffering and no indicators were identified addressing palliative surgery. Future attention is needed toward the development and practical application of palliative care quality indicators in surgical patients.
在重病手术患者中定义高质量的姑息治疗对于提供以患者为中心的外科护理至关重要。为了将姑息治疗纳入现有的外科质量改进计划中，有必要为重病手术患者制定专门的质量指标。
确定现有的衡量重病手术患者姑息治疗提供情况的质量指标，描述其制定过程，并评估其方法学质量。
一项基于 PRISMA 的系统评价纳入了报告成人外科患者姑息治疗质量指标和指南制定过程和特征的研究。将相关措施归入先前定义的姑息治疗国家共识项目领域和 Donabedian 质量框架，并评估其方法学质量。
从 26 项研究中确定了 263 项独特的措施，其中 70%为过程性措施。涉及临终关怀（31.5%）和身体护理方面（20.8%）的指标最为常见。涉及精神（2.6%）和文化护理方面（1.2%）的指标则较为少见。研究之间的方法学质量差异很大。尽管大多数研究都为指标定义了目的，并使用了科学证据，但许多研究缺乏目标人群的投入，很少有研究讨论指标的实际应用。
这项综述是为重病手术患者制定质量指标而进行的关键步骤。很少有指标涉及痛苦的非身体方面，也没有确定针对姑息手术的指标。未来需要关注在外科患者中制定和实际应用姑息治疗质量指标的问题。
