Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA; Center for Health Services Research (M.A.N.), Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.
Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA.
J Pain Symptom Manage. 2023 Jun;65(6):e691-e713. doi: 10.1016/j.jpainsymman.2023.02.001. Epub 2023 Feb 9.
Managing psychological distress is an objective of palliative care. No meta-analysis has evaluated whether palliative care reduces psychological distress.
Examine the effects of palliative care on depression, anxiety, and general psychological distress for adults with life-limiting illnesses and their caregivers.
We searched PubMed, PsycInfo, Embase, and CINAHL for randomized clinical trials (RCTs) of palliative care interventions. RCTs were included if they enrolled adults with life-limiting illnesses or their caregivers, reported data on psychological distress at 3 months after study intake, and if authors had described the intervention as "palliative care."
We identified 38 RCTs meeting our inclusion criteria. Many (14/38) included studies excluded participants with common mental health conditions. There were no statistically significant improvements in patient or caregiver anxiety (patient SMD: -0.008, P = 0.96; caregiver SMD: -0.21, P = 0.79), depression (patient SMD: -0.13, P = 0.25; caregiver SMD -0.27, P = 0.08), or psychological distress (patient SMD: 0.26, P = 0.59; caregiver SMD: 0.04, P = 0.78).
Psychological distress is not likely to be reduced in the context of a typical palliative care intervention. The systemic exclusion of patients with common mental health conditions in more than 1/3 of the studies raises ethical questions about the goals of palliative care RCTS and could perpetuate inequalities.
管理心理困扰是姑息治疗的目标。没有荟萃分析评估姑息治疗是否能减轻心理困扰。
研究姑息治疗对患有绝症的成年人及其照顾者的抑郁、焦虑和一般心理困扰的影响。
我们检索了 PubMed、PsycInfo、Embase 和 CINAHL 中的姑息治疗干预措施的随机临床试验 (RCT)。如果 RCT 招募了患有绝症的成年人或其照顾者，报告了研究开始后 3 个月的心理困扰数据，并且作者将干预描述为“姑息治疗”，则将其纳入研究。
我们确定了 38 项符合我们纳入标准的 RCT。许多（14/38）研究排除了患有常见心理健康疾病的参与者。患者或照顾者的焦虑（患者 SMD：-0.008，P=0.96；照顾者 SMD：-0.21，P=0.79）、抑郁（患者 SMD：-0.13，P=0.25；照顾者 SMD：-0.27，P=0.08）或心理困扰（患者 SMD：0.26，P=0.59；照顾者 SMD：0.04，P=0.78）均无统计学显著改善。
在典型的姑息治疗干预背景下，心理困扰不太可能减轻。超过 1/3 的研究系统地排除了患有常见心理健康疾病的患者，这引发了姑息治疗 RCT 目标的伦理问题，并可能使不平等现象永久化。
