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利用远程医疗为偏远社区提供姑息治疗:快速综述。

Leveraging Telehealth for Delivery of Palliative Care to Remote Communities: A Rapid Review.

机构信息

Department of Nutrition and Dietetics, Idaho State University, Meridian, ID, USA.

College of Pharmacy, Idaho State University, Meridian, ID, USA.

出版信息

J Palliat Care. 2022 Apr;37(2):213-225. doi: 10.1177/08258597211001184. Epub 2021 Mar 18.

Abstract

Palliative care encompasses supportive health care for patients at any stage of illness aimed at relieving symptoms, controlling pain, managing stress, offering respite for caregivers, and optimizing the quality of life. To explore strategies for increasing access to palliative care among individuals living in remote/rural communities, a rapid review was conducted on studies that explored the use of telehealth applications with this population. From December 2019 to February 2020, the PRISMA methodology was used to gather peer-reviewed studies published in the English language. MedLine, Google Scholar, and EBSCO were searched; no date limitations were set. Given the diversity of study methodologies and outcomes, the findings were synthesized narratively. The Cochrane Collaboration's tool for assessing the risk of bias was also employed. Lastly, the studies were mapped to clinical guidelines for the various aspects of quality palliative care. The 18 studies found, published between 2004 and 2019, were conducted in seven countries and on five continents. Aims included evaluating feasibility, efficacy, and user satisfaction. Insights draw from a combined pool of 3,313 patients and 250 providers. Most studies involved oncology patients and employed videoconferencing or a web platform/online software with videoconferencing. Three themes emerged: delivery of care, symptom management and quality of life, and patient/caregiver/provider satisfaction levels. Telehealth proved effective for patient and medication monitoring, provider and specialist appointments, and palliative care consultations. Operational benefits included clinician time saved, shorter appointment wait times, and reduced no show rates; implementation challenges also emerged. Statistical improvements in quality of life and symptom management were reported. Nearly two-thirds of the studies reported positive experiences among patients, caregivers, and providers; about half included an interprofessional team. The studies primarily focused on the structure/process and physical aspects of quality palliative care, there was a paucity of insights on the spiritual, cultural, end of life, and ethical/legal aspects of care. Two-thirds (12/18) of the studies employed a descriptive design. Risk for selection, performance, detection, and reporting biases emerged for all the studies; for example, only four of the studies included control groups and less than 20% (3/18) reported on attrition of study participants. Additional limitations include the rapid review methodology which relied heavily on the lead author's decisions and the restriction of studies published only in the English language. More rigorous research is required to confirm the viability of clinical care delivery and establish best practices for quality, virtual palliative care to remote/rural areas.

摘要

姑息治疗涵盖了对任何疾病阶段的患者进行的支持性医疗保健,旨在缓解症状、控制疼痛、管理压力、为护理人员提供喘息机会,并优化生活质量。为了探索增加远程/农村社区个体获得姑息治疗的策略,我们对使用远程医疗应用程序的人群进行了快速综述。从 2019 年 12 月至 2020 年 2 月,采用 PRISMA 方法收集以英语发表的同行评议研究。检索了 MedLine、Google Scholar 和 EBSCO;没有设置日期限制。鉴于研究方法和结果的多样性,研究结果以叙述方式进行综合。还使用了 Cochrane 协作评估偏倚风险的工具。最后,根据姑息治疗质量的各个方面的临床指南对研究进行了映射。共发现 18 项研究,发表于 2004 年至 2019 年期间,在七个国家和五个大陆进行。目的包括评估可行性、疗效和用户满意度。从 3313 名患者和 250 名提供者的综合数据中得出了见解。大多数研究涉及肿瘤患者,并采用视频会议或具有视频会议的网络平台/在线软件。出现了三个主题:护理的提供、症状管理和生活质量以及患者/护理人员/提供者的满意度水平。远程医疗在患者和药物监测、提供者和专家预约以及姑息治疗咨询方面被证明是有效的。运营效益包括节省临床医生时间、缩短预约等待时间和降低未就诊率;也出现了实施挑战。报告了生活质量和症状管理的统计改善。近三分之二的研究报告了患者、护理人员和提供者的积极体验;约一半的研究包括多专业团队。研究主要集中在姑息治疗的结构/过程和身体方面,关于护理的精神、文化、生命末期和伦理/法律方面的见解很少。三分之二(12/18)的研究采用描述性设计。所有研究都出现了选择、表现、检测和报告偏倚的风险;例如,只有四项研究包括对照组,不到 20%(18/18)的研究报告了研究参与者的流失情况。其他限制包括严重依赖主要作者决策的快速综述方法以及仅限制发表英文研究的限制。需要进行更严格的研究,以确认临床护理提供的可行性,并为远程/农村地区的虚拟姑息治疗建立质量最佳实践。

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