Collins Anna, Hui David, Davison Sara N, Ducharlet Kathryn, Murtagh Fliss, Chang Yuchieh Kathryn, Philip Jennifer
Department of Medicine (A.C., K.D., J.P.), St Vincent's Hospital, University of Melbourne, Australia.
Department of Palliative Care (D.H., Y.K.C.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Pain Symptom Manage. 2023 Nov;66(5):541-550.e1. doi: 10.1016/j.jpainsymman.2023.07.013. Epub 2023 Jul 26.
People with advanced chronic kidney disease (CKD) have significant morbidity, yet for many, access to palliative care occurs late, if at all.
This study sought to examine criteria for referral to specialist palliative care for adults with advanced CKD with a view to improving use of these essential services.
Systematic review of studies detailing referral criteria to palliative care in advanced CKD conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline and registered (PROSPERO: CRD42021230751).
Electronic databases (Ovid, MEDLINE, Ovid Embase, and PubMed) were used to identify potential studies, which were subjected to double review, data extraction, thematic coding, and descriptive analyses.
Searches yielded 650 unique titles ultimately resulting in 56 studies addressing referral criteria to specialist palliative care in advanced CKD. Of 10 categories of referral criteria, most commonly discussed were: Critical times of treatment decision making (n = 23, 41%); physical or emotional symptoms (n = 22, 39%); limited prognosis (n = 18, 32%); patient age and comorbidities (n = 18, 32%); category of CKD/ biochemical criteria (n = 13, 23%); functional decline (n = 13, 23); psychosocial needs (n = 9, 16%); future care planning (n = 9, 16%); anticipated decline in illness course (n = 8, 14%); and hospital use (n = 8, 14%).
Clinicians consider referral to specialist palliative care for a wide range of reasons, with many related to care needs. As palliative care continues to integrate with nephrology, our findings represent a key step towards developing consensus criteria to standardize referral for patients with chronic kidney diseases.
晚期慢性肾脏病（CKD）患者的发病率很高，但对许多患者而言，即使能获得姑息治疗，也往往为时已晚。
本研究旨在探讨晚期CKD成人患者转诊至专科姑息治疗的标准，以改善这些基本服务的利用情况。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，对详细阐述晚期CKD患者姑息治疗转诊标准的研究进行系统评价，并进行报告和注册（PROSPERO：CRD42021230751）。
使用电子数据库（Ovid、MEDLINE、Ovid Embase和PubMed）识别潜在研究，这些研究经过双重审查、数据提取、主题编码和描述性分析。
检索得到650个独特标题，最终有56项研究涉及晚期CKD患者转诊至专科姑息治疗的标准。在10类转诊标准中，最常讨论的是：治疗决策的关键时机（n = 23，41%）；身体或情绪症状（n = 22，39%）；预后有限（n = 18，32%）；患者年龄和合并症（n = 18，32%）；CKD类别/生化标准（n = 13，23%）；功能下降（n = 13，23%）；心理社会需求（n = 9，16%）；未来护理计划（n = 9，16%）；疾病进程预期下降（n = 8，14%）；以及住院使用情况（n = 8，14%）。
临床医生出于多种原因考虑将患者转诊至专科姑息治疗，其中许多原因与护理需求有关。随着姑息治疗继续与肾脏病学相结合，我们的研究结果是朝着制定共识标准以规范慢性肾脏病患者转诊迈出的关键一步。
