临终减药流行病学研究的方法学挑战
Methodological Challenges for Epidemiologic Studies of Deprescribing at the End of Life.
作者信息
Tjia Jennifer, Lund Jennifer L, Mack Deborah S, Mbrah Attah, Yuan Yiyang, Chen Qiaoxi, Osundolire Seun, McDermott Cara L
机构信息
Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA 01605, USA.
Department of Epidemiology, UNC Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, NC, USA.
出版信息
Curr Epidemiol Rep. 2021 Sep;8(3):116-129. doi: 10.1007/s40471-021-00264-7. Epub 2021 Apr 23.
PURPOSE OF REVIEW
To describe approaches to measuring deprescribing and associated outcomes in studies of patients approaching end of life (EOL).
RECENT FINDINGS
We reviewed studies published through 2020 that evaluated deprescribing in patients with limited life expectancy and approaching EOL. Deprescribing includes reducing the number of medications, decreasing medication dose(s), and eliminating potentially inappropriate medications. Tools such as STOPPFrail, OncPal, and the Unnecessary Drug Use Measure can facilitate deprescribing. Outcome measures vary and selection of measures should align with the operationalized deprescribing definition used by study investigators.
SUMMARY
EOL deprescribing considerations include medication appropriateness in the context of patient goals for care, expected benefit from medication given life expectancy, and heightened potential for medication-related harm as death nears. Additional data are needed on how EOL deprescribing impacts patient quality of life, caregiver burden, and out-of-pocket medication-related costs to patients and caregivers. Investigators should design deprescribing studies with this information in mind.
综述目的
描述在接近生命末期（EOL）患者的研究中衡量减药及相关结果的方法。
最新发现
我们回顾了截至2020年发表的评估预期寿命有限且接近EOL患者减药情况的研究。减药包括减少药物数量、降低药物剂量以及停用潜在不适当的药物。诸如STOPPFrail、OncPal和不必要药物使用测量等工具可促进减药。结果测量方法各不相同，测量方法的选择应与研究调查人员所采用的减药定义操作化相一致。
总结
EOL减药的考虑因素包括在患者护理目标背景下药物的适当性、鉴于预期寿命药物的预期益处以及随着死亡临近药物相关伤害的可能性增加。关于EOL减药如何影响患者生活质量、照顾者负担以及患者和照顾者的自付药物相关费用，还需要更多数据。研究人员在设计减药研究时应牢记这些信息。
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