New York University, New York, New York, USA.
Weill Cornell Medicine New York, New York, USA.
J Pain Symptom Manage. 2021 Sep;62(3):e248-e260. doi: 10.1016/j.jpainsymman.2021.04.025. Epub 2021 May 11.
Persons from underrepresented racial and ethnic groups experience disparities in access to and quality of palliative and end-of-life care.
To summarize and evaluate existing palliative and end-of-life care interventions that aim to improve outcomes for racial and ethnic underrepresented populations in the United States.
We conducted a systematic review of the literature in the English language from four databases through January 2020. Peer-reviewed studies that implemented interventions on palliative care, advance care planning, or end-of-life care were considered eligible. Data were extracted from 16 articles using pre-specified inclusion and exclusion criteria. Quality was appraised using the modified Downs and Black tool for assessing risk of bias in quantitative studies.
Five studies were randomized controlled trials, and the remainder were quasi-experiments. Six studies targeted Latino/Hispanic Americans, five African Americans, and five, Asian or Pacific Islander Americans. The two randomized control trials reviewed and rated "very high" quality, found educational interventions to have significant positive effects on advance care planning and advance directive completion and engagement for underrepresented racial or ethnic groups.
The effectiveness of advance care planning, end-of-life, and palliative care interventions in improving outcomes for underrepresented racial and ethnic populations remains uncertain. Randomized controlled trials and educational interventions indicate that interventions targeting underrepresented groups can have significant and positive effects on advance directives and/or advance care planning-related outcomes. More high-quality intervention studies that address racial and ethnic health disparities in palliative care are needed, particularly those that address systemic racism and other complex multilevel factors that influence disparities in health.
代表性不足的种族和族裔群体在获得姑息治疗和临终关怀的机会以及护理质量方面存在差异。
总结和评估旨在改善美国代表性不足的种族和族裔人群的姑息治疗和临终关怀结局的现有姑息治疗和临终关怀干预措施。
我们对四个数据库中的英文文献进行了系统评价，检索时间截至 2020 年 1 月。纳入了实施姑息治疗、预先医疗指示或临终关怀干预措施的同行评议研究。使用预先规定的纳入和排除标准从 16 篇文章中提取数据。使用改良的 Downs 和 Black 工具评估定量研究的偏倚风险来评估质量。
五项研究为随机对照试验，其余为准实验。六项研究针对拉丁裔/西班牙裔美国人，五项研究针对非裔美国人，五项研究针对亚裔或太平洋岛民美国人。综述和评价的两项随机对照试验质量“非常高”，发现教育干预措施对代表性不足的种族或族裔群体的预先医疗指示完成和参与具有显著的积极影响。
在改善代表性不足的种族和族裔人群的结局方面，预先医疗指示、临终关怀和姑息治疗干预措施的有效性仍不确定。随机对照试验和教育干预措施表明，针对代表性不足群体的干预措施可以对预先医疗指示和/或预先医疗指示相关结局产生重大和积极的影响。需要更多高质量的干预研究来解决姑息治疗中的种族和族裔健康差异问题，特别是那些涉及系统性种族主义和其他影响健康差异的复杂多层次因素的研究。
