Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway.
Faculty of Health Sciences, VID Specialized University, Mail Box 184 Vinderen, 0319, Oslo, Norway.
BMC Palliat Care. 2024 Jan 29;23(1):27. doi: 10.1186/s12904-024-01365-y.
Patients with severe chronic obstructive pulmonary disease (COPD) could have palliative care (PC) needs because of unmet needs such as dyspnoea. This may lead to anxiety and may have an impact on patients' ability to perform daily activities of living. PC can be started when patients with COPD have unmet needs and can be provided alongside disease-modifying therapies. Non-invasive ventilation (NIV) could be an important measure to manage dyspnoea in patients with COPD in need of PC. A scoping review was conducted to gain an overview of the existing research and to identify knowledge gaps. The aim of this scoping review was to systematically map published studies on the use of NIV in patients with COPD with PC needs, including the perspectives and experiences of patients, families, and healthcare professionals (HCPs).
This review was conducted following the framework of Arksey and O'Malley. The reporting of the review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. The review protocol was published. AMED, CINAHL, Embase, MEDLINE, PEDro, and PsycInfo were searched from inception to November 14, 2022. The included studies had to report the perspectives and experiences of COPD patients, relatives, and HCPs regarding NIV in the care of patients with COPD with PC needs. In pairs, the authors independently assessed studies' eligibility and extracted data. The data were organised thematically. The results were discussed in a consultation exercise.
This review included 33 papers from 32 studies. Four thematic groupings were identified: preferences and attitudes towards the use of NIV; patient participation in the decision-making process of NIV treatment; conflicting results on the perceived benefits and burdens of treatment; and heterogenous clinical outcomes in experimental studies. Patients perceived NIV as a 'life buoy' to keep them alive. Many patients wanted to take part in the decision-making process regarding NIV treatment but expressed varying degrees of inclusion by HCPs in such decision-making. Conflicting findings were identified regarding the perceived benefits and burdens of NIV treatment. Diversity in heterogeneous clinical outcomes were reported in experimental studies.
There is a need for more studies designed to investigate the effectiveness of NIV as a palliative measure for patients with COPD with PC needs using comprehensive outcomes. It is especially important to gain more knowledge on the experiences of all stakeholders in the use of home-based NIV treatment to these patients.
严重慢性阻塞性肺疾病（COPD）患者可能存在姑息治疗（PC）需求，因为存在未满足的需求，例如呼吸困难。这可能导致焦虑，并可能影响患者进行日常活动的能力。当 COPD 患者存在未满足的需求时，可以开始提供 PC 治疗，并且可以与改变疾病的治疗方法同时提供。无创通气（NIV）可能是管理需要 PC 的 COPD 患者呼吸困难的重要措施。进行了一项范围综述，以全面了解现有研究并确定知识空白。本范围综述的目的是系统地绘制关于使用 NIV 治疗有 PC 需求的 COPD 患者的已发表研究，包括患者、家属和医疗保健专业人员（HCP）的观点和经验。
本综述遵循 Arksey 和 O'Malley 的框架进行。该综述的报告遵循系统评价和荟萃分析扩展的首选报告项目对范围综述清单的指导。综述方案已发布。从成立到 2022 年 11 月 14 日，在 AMED、CINAHL、Embase、MEDLINE、PEDro 和 PsycInfo 中进行了搜索。纳入的研究必须报告 COPD 患者、亲属和 HCP 对 COPD 患者 PC 需求护理中 NIV 的观点和经验。作者成对独立评估研究的合格性并提取数据。数据按主题组织。结果在磋商中进行了讨论。
本综述包括来自 32 项研究的 33 篇论文。确定了四个主题分组：对使用 NIV 的偏好和态度；患者参与 NIV 治疗决策过程；对治疗的预期益处和负担存在冲突结果；以及实验研究中异质的临床结局。患者将 NIV 视为维持生命的“救生圈”。许多患者希望参与 NIV 治疗决策过程，但表示 HCP 在这种决策中的参与程度各不相同。对 NIV 治疗的预期益处和负担存在冲突结果。实验研究报告了异质临床结局的多样性。
需要更多研究来调查 NIV 作为 COPD 患者 PC 需求的姑息治疗措施的有效性，使用综合结局。特别重要的是，需要更多地了解所有利益相关者在为这些患者使用家庭 NIV 治疗方面的经验。
