Robinson Lucy, Dewhurst Felicity, Huggin Amy, Stow Daniel, Stenson Charlotte, Westhead Elizabeth, Frew Katie, Hanratty Barbara, Paes Paul
Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
Northumbria Healthcare NHS Foundation Trust, Northumberland, UK.
Palliat Med. 2025 Jun;39(6):665-677. doi: 10.1177/02692163251331161. Epub 2025 Apr 25.
Understanding the evolution of end-of-life preferences over time is important for dynamic, person-centred palliative care. This is particularly relevant for older people whose preferences can be incompletely expressed and subject to change.
To summarise the nature of the current evidence about how and why the end-of-life preferences of older people change over time.
A scoping review was performed, using a predefined protocol and following the JBI manual for evidence synthesis.
Final searches of Medline, Embase, PsycINFO and Web of Science were carried out in October 2023. Reference lists were also reviewed. Eligibility criteria included studies recruiting people over the age of 60 that explored how or why end-of-life preferences developed over time.
Screening identified 52 articles, reporting on 40 studies. A majority were longitudinal studies collecting quantitative data about treatment preferences. Other preference categories included euthanasia, balancing quality and length of life, goals of care, preferred place of death, decision-making and spiritual preferences. Studies explored a variety of factors that may influence preference change or stability. There was a lack of research with ethnic minority groups and people aged over 80.
Existing research has focused on preferences about specific therapies, at the expense of understanding what matters most to older people. Synthesis of the available evidence about why preferences change will guide reviews of patients' advance care plans. To inform dynamic, person-centred end-of-life care we need studies prospectively exploring how older people construct a broader range of preferences, and negotiate these over time.
了解临终偏好随时间的演变对于动态的、以患者为中心的姑息治疗至关重要。这对于那些偏好可能表达不完整且会发生变化的老年人尤为重要。
总结关于老年人临终偏好如何以及为何随时间变化的现有证据的性质。
采用预定义方案并遵循JBI证据综合手册进行了一项范围综述。
2023年10月对Medline、Embase、PsycINFO和科学网进行了最终检索。还对参考文献列表进行了审查。纳入标准包括招募60岁以上人群的研究，这些研究探讨了临终偏好如何或为何随时间发展。
筛选出52篇文章，报道了40项研究。大多数是收集关于治疗偏好的定量数据的纵向研究。其他偏好类别包括安乐死、平衡生活质量和寿命、护理目标、首选死亡地点、决策制定和精神偏好。研究探讨了各种可能影响偏好变化或稳定性的因素。缺乏针对少数族裔群体和80岁以上人群的研究。
现有研究集中在对特定疗法的偏好上，而忽视了对老年人最重要的事情的理解。综合关于偏好变化原因的现有证据将指导对患者预先护理计划的审查。为了为动态的、以患者为中心的临终护理提供信息，我们需要前瞻性研究，以探索老年人如何构建更广泛的偏好，并随着时间推移进行协商。
