Gautama Made Satya Nugraha, Damayanti Adelina, Khusnia Anindita Farda
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Indian J Palliat Care. 2023 Jan-Mar;29(1):28-35. doi: 10.25259/IJPC_153_2022. Epub 2022 Sep 7.
Palliative care is often started late in patients with life-threatening conditions, particularly in patients with advanced cancer. However, with the emergence of the early palliative care (EPC) paradigm, their quality of life (QoL) may be better. Although several previous meta-analyses support the effectiveness of EPC in increasing QoL, essential issues related to the optimisation of EPC interventions are still needed. A systematic review and meta-analysis of randomised controlled trials (RCTs) were conducted to determine the effectiveness of EPC on the QoL of patients with advanced cancer. PubMed, ProQuest, MEDLINE through EBSCOhost and Cochrane Library and clinicaltrials.gov (register website) were searched for RCTs published before May 2022. Data synthesis used the Review Manager 5.4 to generate pooled estimates of effect size. A total of 12 empirical trials met the eligibility criteria and were included in this study. The results showed that EPC intervention had a significant effect (standard mean difference = 0.16, 95% confidence interval: 0.04, 0.28, Z = 2.68, < 0.05). However, the secondary outcomes showed including mood (mean difference = -0.90, 95% CI: -2.32, 0.51, > 0.05) and symptom controls (MD = -1.49, 95% CI: -3.81, 0.81, > 0.05) had no significant effect. EPC is effective in improving the QoL of patients with advanced cancer. However, other outcomes still need to be reviewed, because the review of QoL is not enough to generalise the benchmarks for the effectiveness and optimisation of EPC interventions. Another notable aspect is to consider the most effective and efficient duration for starting and ending EPC interventions.
姑息治疗通常在患有危及生命疾病的患者中开展得较晚，尤其是晚期癌症患者。然而，随着早期姑息治疗（EPC）模式的出现，他们的生活质量（QoL）可能会更好。尽管此前的几项荟萃分析支持EPC在提高生活质量方面的有效性，但仍需要解决与优化EPC干预措施相关的关键问题。本研究进行了一项随机对照试验（RCT）的系统评价和荟萃分析，以确定EPC对晚期癌症患者生活质量的有效性。通过检索PubMed、ProQuest、EBSCOhost平台的MEDLINE、Cochrane图书馆以及clinicaltrials.gov（注册网站），查找2022年5月之前发表的RCT。数据合成使用Review Manager 5.4生成效应量的合并估计值。共有12项实证试验符合纳入标准并被纳入本研究。结果显示，EPC干预有显著效果（标准化均数差=0.16，95%置信区间：0.04，0.28，Z=2.68，P<0.05）。然而，次要结果显示，包括情绪（均数差=-0.90，95%CI：-2.32，0.51，P>0.05）和症状控制（MD=-1.49，95%CI：-3.81，0.81，P>0.05）均无显著效果。EPC在改善晚期癌症患者生活质量方面是有效的。然而，其他结果仍需进一步审视，因为仅对生活质量进行评价不足以概括EPC干预措施有效性和优化的基准。另一个值得注意的方面是考虑开始和结束EPC干预的最有效和高效的持续时间。
