Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore.
Semin Oncol Nurs. 2024 Dec;40(6):151753. doi: 10.1016/j.soncn.2024.151753. Epub 2024 Nov 16.
While Home-based palliative care might be the preferred choice of many, there has been little research exploring the experiences of older adults and caregivers in this setting. This systematic review aims to explore and synthesize the experiences of home-dwelling older adults (aged 60 and above) and their caregivers with Home-based palliative care.
A Systematic Review and Meta-Synthesis of qualitative and mixed-methods studies was conducted and reported in accordance with PRISMA guidelines. A systematic search across nine electronic databases, as well as grey literature, reference lists and citation lists were conducted. Studies were included with the following criteria: older adult palliative patients and/or their informal caregivers with the primary setting of palliative care delivery at home. Quality appraisal was conducted by two researchers independently using the Critical Appraisal Skills Programme Qualitative Research Checklist and Mixed Methods Appraisal Tool. Data analysis was facilitated by Braun and Clark's thematic analysis, and meta-synthesis was underpinned by Sandelowski and Barroso's guidelines.
A total of 4,931 records were yielded through the electronic database search. After duplicate removal and screening of titles/abstracts and full-texts, a total of 25 studies were included. Five main themes and 11 sub-themes emerged: 1) Living in a diminishing world due to immobility, 2) Bittersweet caregiving process, 3) Navigating a fragmented healthcare system, 4) Maintaining normalcy amongst disruption, 5) Indispensable aspects of Home-based palliative care needed by families.
This meta-synthesis highlights the fundamental significance of embracing a dyadic approach to fully comprehend the intricate dynamics of Home-based palliative care. By recognising the older adult-caregiver dyad as an interconnected unit, future research, therapeutic interventions, and policy initiatives can integrate this dyadic perspective, resulting in more holistic and inclusive Home-based palliative care programs.
The protocol was registered on PROSPERO (Registration No. CRD42022376864).
虽然居家姑息治疗可能是许多人的首选，但很少有研究探索这一环境中老年人及其照顾者的体验。本系统评价旨在探索和综合居家老年人（60 岁及以上）及其照顾者接受居家姑息治疗的体验。
根据 PRISMA 指南，对定性和混合方法研究进行了系统评价和元综合。对九个电子数据库以及灰色文献、参考文献列表和引文列表进行了系统搜索。符合以下标准的研究被纳入：姑息治疗的主要场所是居家的老年姑息治疗患者和/或他们的非正式照顾者。两名研究人员使用批判性评估技能计划定性研究清单和混合方法评估工具独立进行质量评估。数据分析由 Braun 和 Clark 的主题分析协助，元综合由 Sandelowski 和 Barroso 的指南支持。
通过电子数据库搜索共产生了 4931 条记录。经过重复去除以及标题/摘要和全文筛选后，共有 25 项研究被纳入。出现了五个主要主题和 11 个次主题：1）由于行动不便，生活在一个逐渐缩小的世界中；2）苦乐参半的照顾过程；3）在碎片化的医疗保健系统中导航；4）在混乱中保持常态；5）家庭需要的居家姑息治疗不可或缺的方面。
该元综合强调了采用对偶方法的重要性，以便充分理解居家姑息治疗的复杂动态。通过将老年患者-照顾者对偶视为一个相互关联的单元，未来的研究、治疗干预和政策倡议可以整合这种对偶观点，从而使居家姑息治疗计划更加全面和包容。
该方案在 PROSPERO（注册号：CRD42022376864）上进行了注册。
