Department of Health Policy, Laboratory for Quality Assessment of Care and Services, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
Department of Oncology, Laboratory of Clinical Research Methodology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
J Eval Clin Pract. 2022 Jun;28(3):371-381. doi: 10.1111/jep.13674. Epub 2022 Mar 30.
To systematically review the evidence from randomized controlled trials comparing the effects of goal-oriented care against standard care for multimorbid adults.
DATA SOURCES/STUDY SETTING: The literature presenting the results of randomized trials assessing the outcomes of goal-oriented care compared with usual care for adults with multimorbidity.
Systematic review and meta-analysis.
DATA COLLECTION/EXTRACTION METHODS: We searched the Cochrane Database of Systematic Reviews (CENTRAL), EMBASE, MEDLINE, CINHAL, trial registries such as ClinicalTrial.gov and World Health Organization International Clinical Trials Registry Platform (ICTRP), and the references of eligible trials and relevant reviews. Goal-oriented care was defined as an approach that engages patients, establishes personal goals, and sets targets for patients and clinicians to plan a course of action and measure outcome. We reviewed 228 trials, and 12 were included. We extracted outcome data on quality of life, hospital admission, patients' satisfaction, patient and caregiver burden. Risk of bias was assessed and certainty of evidence was evaluated using GRADE.
No study was fully free of bias. No effect was found on quality of life (standardized mean difference [SMD]: 0.05; 95% CI: -0.05 to 0.16) and hospital admission (risk ratio [RR]: 0.87; 95% CI: 0.65 to 1.17). There was a very small effect for patients' satisfaction (SMD: 0.15; 95% CI: 0.00 to 0.29) and caregiver burden (SMD: -0.13; 95% CI: -0.26 to 0.00). Certainty of evidence was low for all outcomes.
No firm conclusions can be reached about the effects of goal-oriented care for multimorbid adults. Future research should overcome the shortcomings of trials assessed in this meta-analysis. Sound application of the indications for research of complex healthcare interventions is warranted.
系统回顾比较面向目标的护理与标准护理对多病成年人影响的随机对照试验证据。
数据来源/研究设置：呈现评估面向目标的护理与多病成年人常规护理结局的随机试验结果的文献。
系统综述和荟萃分析。
数据收集/提取方法：我们检索了 Cochrane 系统评价数据库（CENTRAL）、EMBASE、MEDLINE、CINHAL、临床试验注册库，如 ClinicalTrials.gov 和世界卫生组织国际临床试验注册平台（ICTRP），以及合格试验和相关综述的参考文献。面向目标的护理被定义为一种使患者参与、确定个人目标，并为患者和临床医生设定目标以规划行动过程和衡量结果的方法。我们共审查了 228 项试验，其中 12 项被纳入。我们提取了生活质量、住院、患者满意度、患者和照护者负担等结局的数据。使用 GRADE 评估偏倚风险和证据确定性。
没有研究完全没有偏倚。生活质量方面未发现效果（标准化均数差 [SMD]：0.05；95%置信区间 [CI]：-0.05 至 0.16），住院方面也未发现效果（风险比 [RR]：0.87；95% CI：0.65 至 1.17）。患者满意度方面有很小的效果（SMD：0.15；95% CI：0.00 至 0.29），照护者负担方面也有很小的效果（SMD：-0.13；95% CI：-0.26 至 0.00）。所有结局的证据确定性都很低。
对于多病成年人的面向目标的护理效果，无法得出确切结论。未来的研究应克服本荟萃分析评估试验的缺点。有必要合理应用复杂医疗干预措施的研究适应证。
