医院发起的衰弱成年人姑息治疗干预措施：系统评价和叙述性综合的结果。

Hospital-initiated palliative care interventions for adults with frailty: findings from a systematic review and narrative synthesis.

机构信息

Health Innovation Campus, Lancaster University, Bailrigg, Lancaster LA1 4YW, UK.

Division of Medicine, University College London, London, UK.

出版信息

Age Ageing. 2024 Sep 1;53(9). doi: 10.1093/ageing/afae190.

DOI:10.1093/ageing/afae190

PMID:39287003

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11406057/

Abstract

BACKGROUND

Adults with frailty have palliative care needs [1] but have disproportionately less access to palliative care services [2]. Frailty affects ~4000 patients admitted to hospital per day in the UK [3], making the hospital admission a unique opportunity to assess palliative care needs and deliver interventions.

OBJECTIVES

Synthesise the evidence regarding hospital palliative care (HPC) for patients with frailty. Narratively analyse the evidence regarding methods used to identify palliative care needs; types of palliative care interventions studied; and whether HPC improves outcomes.

METHODS

Systematic literature review and narrative synthesis of experimental, observational and systematic review articles investigating palliative care interventions for hospitalised adults aged ≥65 years with frailty. Electronic search of five databases from database inception to 30 January 2023. Included studies analysed using narrative synthesis according to Popay et al [4].

RESULTS

15 465 titles retrieved, 12 included. Three studies detailed how they identified palliative care needs; all three used prognostication e.g. the 'surprise question'. Most papers (10/12) investigated specialist palliative care interventions. These interventions addressed a wider range of care needs than non-specialist interventions. Evidence suggested an improvement in some symptom burden and healthcare utilisation outcomes following HPC.

CONCLUSION

Prognostication was the main method of identifying palliative care needs, rather than individuals' specific needs. Specialist palliative care interventions were more holistic, indicating that non-specialist palliative care approaches may benefit from specialist team input. Despite suggestions of improvement in some outcomes with palliative care, heterogenous evidence prevented establishment of conclusive effects.

摘要

背景

虚弱的成年人有姑息治疗需求[1]，但获得姑息治疗服务的机会却不成比例地少[2]。在英国，每天约有 4000 名患者因虚弱而住院[3]，这使得住院成为评估姑息治疗需求和提供干预措施的独特机会。

目的

综合虚弱患者的医院姑息治疗（HPC）证据。对用于识别姑息治疗需求的方法、研究的姑息治疗干预类型以及 HPC 是否改善结局的证据进行叙述性分析。

方法

系统检索了从数据库创建到 2023 年 1 月 30 日的五个数据库，对调查 65 岁及以上虚弱住院成年人姑息治疗干预措施的实验、观察和系统评价文章进行了系统文献综述和叙述性综合分析。根据 Popay 等人[4]的方法，对纳入的研究进行叙述性分析。

结果

共检索到 15465 个标题，纳入 12 项研究。有 3 项研究详细说明了他们如何识别姑息治疗需求；这三项研究都使用了预后评估，例如“意外问题”。大多数论文（12 篇中的 10 篇）研究了专门的姑息治疗干预措施。这些干预措施解决了更广泛的护理需求，而不仅仅是非专业干预措施。有证据表明，HPC 后一些症状负担和医疗保健利用结果有所改善。