Dingley Catherine, Ruckdeschel Angela, Kotula Keshia, Lekhak Nirmala
School of Nursing, University of Nevada, Las Vegas, Box 453018, 4505 S. Maryland Pkwy., Las Vegas, NV 89154-3018, USA.
Department of Physiology and Biophysics, School of Medicine, The University of Mississippi, Jackson, MS, USA.
Palliat Care Soc Pract. 2021 Oct 26;15:26323524211051753. doi: 10.1177/26323524211051753. eCollection 2021.
Complementary therapies are increasingly integrated into hospice care, emphasizing the need to examine the evidence regarding implementation and effects on end-of-life outcomes. This review synthesizes the evidence regarding the implementation of complementary therapies and effects on end-of-life outcomes in hospice care. Whittemore and Knafl's five-step integrative review process was applied. Using predefined search terms, research-based articles between 2006 and 2020 were reviewed. Twenty-three quantitative/mixed method studies conducted across eight countries met the final review criteria. Most commonly used complementary therapies were music, biofield therapies (reiki, therapeutic touch), and massage therapy. Most studies reported significant findings on physical symptoms (pain, dyspnea, fatigue, gastrointestinal symptoms, agitation) and/or psychosocial/spiritual symptoms (anxiety, depression, spirituality, well-being, quality of life); 40% of studies had both significant and nonsignificant findings. Methodological limitations included study design (few randomized controlled trials), small sample size, high attrition rate, lack of racial/ethnic diversity, unstandardized intervention implementation, and multiple outcome measurement instruments. Complementary therapies are promising components of hospice care; however, rigorous studies are needed to validate the effect on end-of-life outcomes and determine the most efficacious implementation. Complementary therapy studies face challenges consistent with end-of-life research; however, efforts to design rigorous trials and address methodological issues are required to enhance the state of the science.
补充疗法越来越多地融入临终关怀护理中，这凸显了审视关于其实施情况及对临终结局影响的证据的必要性。本综述综合了关于补充疗法在临终关怀护理中的实施情况及其对临终结局影响的证据。采用了惠特莫尔和克纳夫的五步综合综述流程。使用预先确定的检索词，对2006年至2020年间基于研究的文章进行了综述。在八个国家开展的23项定量/混合方法研究符合最终综述标准。最常用的补充疗法是音乐、生物场疗法（灵气疗法、治疗性触摸）和按摩疗法。大多数研究报告了在身体症状（疼痛、呼吸困难、疲劳、胃肠道症状、烦躁不安）和/或心理社会/精神症状（焦虑、抑郁、精神性、幸福感、生活质量）方面的显著结果；40%的研究既有显著结果也有非显著结果。方法学上的局限性包括研究设计（随机对照试验较少）、样本量小、损耗率高、缺乏种族/民族多样性、干预实施不规范以及多种结局测量工具。补充疗法是临终关怀护理中有前景的组成部分；然而，需要进行严格的研究来验证其对临终结局的影响，并确定最有效的实施方式。补充疗法研究面临着与临终研究一致的挑战；然而，需要努力设计严格的试验并解决方法学问题，以提升该领域的科学水平。
