Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, Sichuan University West China Hospital, Chengdu, China.
J Am Geriatr Soc. 2021 Jun;69(6):1659-1669. doi: 10.1111/jgs.17070. Epub 2021 Mar 2.
Patients with dementia often have significant symptom burden and a progressive course of functional deterioration. Specialist palliative care referral may be helpful, but it is unclear who and when patients should be referred. We conducted a systematic review of the literature to examine referral criteria for palliative care among patients with dementia.
We searched Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, Cochrane Library, PubMed, and CINAHL databases for articles from inception to December 3, 2019, related to specialist palliative care referral for dementia. Two investigators independently reviewed the citations for inclusion, extracted the referral criteria, and categorized them thematically.
Of the 1788 citations, 59 articles were included in the final sample. We identified 13 categories of referral criteria, including 6 disease-based and 7 needs-based criteria. The most commonly discussed criterion was "dementia stage" (n = 43, 73%), followed by "new diagnosis of dementia" (n = 17, 29%), "medical complications of dementia" (n = 12, 20%), "prognosis" (n = 11, 19%), and "physical symptoms" (n = 11, 19%). Under dementia stage, 37/44 (84%) articles recommended a palliative care referral for advanced dementia. Pneumonia (n = 6, 10%), fall/fracture (n = 4, 7%), and decubitus ulcers (n = 4, 7%) were most commonly discussed complications to trigger a referral. Under prognosis, the time frame for referral varied from <2 years of life expectancy to <6 months. 3 (5%) of articles recommended "surprise question" as a potential trigger.
This systematic review highlighted the lack of consensus regarding referral criteria for palliative care in patients with dementia and the need to identify timely triggers to standardize referral.
痴呆症患者往往有显著的症状负担和进行性的功能恶化。向专业的姑息治疗团队转介可能会有所帮助，但不清楚何时以及应该向哪些患者转介。我们进行了一项系统综述，以检查痴呆症患者接受姑息治疗的转介标准。
我们在 Ovid MEDLINE、Ovid Embase、Ovid PsycInfo、Cochrane 图书馆、PubMed 和 CINAHL 数据库中搜索了从开始到 2019 年 12 月 3 日的与痴呆症的姑息治疗转介相关的文章。两名调查员独立审查了纳入的参考文献，提取了转介标准，并进行了主题分类。
在 1788 条引用文献中，有 59 篇文章最终纳入了样本。我们确定了 13 类转介标准，包括 6 类疾病标准和 7 类需求标准。讨论最多的标准是“痴呆症阶段”（n=43，73%），其次是“新诊断的痴呆症”（n=17，29%）、“痴呆症的医疗并发症”（n=12，20%）、“预后”（n=11，19%）和“身体症状”（n=11，19%）。在痴呆症阶段，44 篇文章中有 37 篇（84%）建议对晚期痴呆症进行姑息治疗转介。最常讨论的并发症有肺炎（n=6，10%）、跌倒/骨折（n=4，7%）和压疮（n=4，7%）。在预后方面，转介的时间范围从预期寿命不足 2 年到不足 6 个月不等。有 3 篇（5%）文章建议“意外问题”作为潜在的触发因素。
本系统综述强调了痴呆症患者姑息治疗转介标准缺乏共识，需要确定及时的触发因素以实现转介的标准化。
