McConvey Kayla, Kazazian Karnig, Iansavichene Alla E, Jenkins Mary E, Gofton Teneille Emma
Department of Clinical Neurological Sciences (KM, KK, MEJ, TEG), Western University, London, Ontario, Canada; and Library Services (AEI), London Health Sciences Centre, Ontario, Canada.
Neurol Clin Pract. 2022 Jun;12(3):190-202. doi: 10.1212/CPJ.0000000000001159.
To systematically review the literature for the most suitable trigger criteria for referral to specialist palliative care services in life-limiting and life-threatening neurologic and neurosurgical conditions.
Literature searches were conducted in Ovid MEDLINE and EMBASE (1990-December 2020). To be included, studies must have trigger/referral criteria clearly outlined, a ≥75% nononcology neurosciences population, and consensus or guidelines documents regarding palliative neurosciences or trigger/referral criteria. We excluded studies that had an oncologic or non-neurosciences population as the main focus of study, trigger and referral criteria not clearly outlined, and no primary or duplicative data. The protocol was registered with PROSPERO (CRD4202013579), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The American Academy of Neurology was used to assess for risk of bias.
Our search identified 1,748 publications, of which 22 articles met the eligibility criteria. Studies were considered in 2 main groups: (A) studies designed specifically to identify trigger criteria for referral to specialized neuropalliative care services (n = 9) and (B) studies that retrospectively reported the reason for referral to specialized palliative care or reflected a consensus statement among people with advanced neurologic illness (n = 13). Overall, the results suggest that several published referral triggers for specialized neuropalliative care are based on expert consensus. However, there is a growing body of literature providing evidence-based condition-specific triggers for multiple sclerosis, parkinsonism, amyotrophic lateral sclerosis, and dementia.
There is a growing body of research that outlines evidence-based referral triggers for neuropalliative care. The ambiguity of nomenclature surrounding referral triggers in the current literature and field of neuropalliative care was a limitation to this study. We suggest that condition-specific triggers are likely to be the most effective for identifying the appropriate patients and timing for referral to specialist palliative care. (PROSPERO registration number: CRD42020135791, crd.york.ac.uk/prospero).
系统回顾文献，以找出在危及生命和有生命危险的神经及神经外科疾病中，最适合转介至专科姑息治疗服务的触发标准。
在Ovid MEDLINE和EMBASE（1990年至2020年12月）中进行文献检索。纳入的研究必须明确列出触发/转介标准，非肿瘤神经科学人群比例≥75%，且有关于姑息性神经科学或触发/转介标准的共识或指南文件。我们排除了以肿瘤或非神经科学人群为主要研究重点、触发和转介标准未明确列出以及无原始或重复数据的研究。该方案已在PROSPERO（CRD4202013579）注册，并遵循系统评价和Meta分析的首选报告项目指南。采用美国神经病学学会来评估偏倚风险。
我们的检索共识别出1748篇出版物，其中22篇文章符合纳入标准。研究主要分为2组：（A）专门设计用于确定转介至专科神经姑息治疗服务的触发标准的研究（n = 9），以及（B）回顾性报告转介至专科姑息治疗原因或反映晚期神经疾病患者共识声明的研究（n = 13）。总体而言，结果表明，一些已发表的专科神经姑息治疗转介触发因素是基于专家共识。然而，越来越多的文献为多发性硬化症、帕金森症、肌萎缩侧索硬化症和痴呆症提供了基于证据的特定疾病触发因素。
越来越多的研究概述了神经姑息治疗基于证据的转介触发因素。当前神经姑息治疗文献和领域中转介触发因素命名的模糊性是本研究的一个局限。我们认为，特定疾病的触发因素可能最有效地识别合适的患者以及转介至专科姑息治疗的时机。（PROSPERO注册号：CRD42020135791，crd.york.ac.uk/prospero）
