Singh Gursharan K, Virdun Claudia, Rattray Megan, Prichard Roslyn, Wynne Rochelle
Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
Int J Nurs Stud Adv. 2025 May 1;8:100343. doi: 10.1016/j.ijnsa.2025.100343. eCollection 2025 Jun.
Optimal palliative care requires a correct assessment of needs. Nurses are well-placed to undertake this task, but the effectiveness of nurse-led palliative care needs assessment remains uncertain.
To evaluate the evidence regarding the impact of nurse-led palliative care needs assessment on adult patients with oncological and non-oncological illnesses quality of life, symptom burden and hospitalisations.
Systematic review. The review was registered on the international Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42023429259).
Databases searched were CINAHL, PubMed, Embase, and MEDLINE from inception to April 2024.
A systematic review of English language, randomised controlled trials, conducted in May 2023, and updated in April 2024, on the impact of nurse-led palliative care needs assessment was undertaken. Two independent reviewers screened papers, and two reviewers independently conducted data extraction and risk of bias assessment using the Cochrane Risk of Bias 2 tool. The data were analysed using a narrative synthesis approach by combining studies according to the outcomes of interest.
Six trials were included, involving oncological patients ( = 4), non-oncological patients ( = 1) and deceased aged-care residents ( = 1). Two studies had 'low' risk of bias, two had 'some concerns,' and two had 'high concerns.' There was heterogeneity in the needs assessment tools used and the outcome measures assessed. Researchers who conducted a nurse-led and social worker-led trial in non-oncological patients demonstrated statistically significant improvements in patient quality-of-life and symptom burden. Researchers in two trials found no difference, and two others reported statistically non-significant improvements in quality of life and symptom burden. One group of researchers found no difference in hospitalisations at 6 months. No studies evaluated the inpatient length of stay.
There is a paucity of high-quality evidence on the effectiveness of nurse-led palliative care needs assessments. Future researchers must identify what level of needs predicts poor quality of life, assess interventions tailored to local contexts, and determine how best to evaluate their impact using clinically relevant outcome measures.
最佳的姑息治疗需要对需求进行正确评估。护士很适合承担这项任务，但由护士主导的姑息治疗需求评估的有效性仍不确定。
评估关于护士主导的姑息治疗需求评估对成年肿瘤和非肿瘤疾病患者生活质量、症状负担和住院情况影响的证据。
系统评价。该评价已在国际前瞻性系统评价注册库（PROSPERO）上注册（注册号CRD42023429259）。
检索的数据库为CINAHL、PubMed、Embase和MEDLINE，检索时间从建库至2024年4月。
于2023年5月对关于护士主导的姑息治疗需求评估影响的英文随机对照试验进行系统评价，并于2024年4月更新。两名独立评审员筛选论文，两名评审员使用Cochrane偏倚风险2工具独立进行数据提取和偏倚风险评估。通过根据感兴趣的结果合并研究，采用叙述性综合方法对数据进行分析。
纳入六项试验，涉及肿瘤患者（n = 4）、非肿瘤患者（n = 1）和老年护理机构已故居民（n = 1）。两项研究存在“低”偏倚风险，两项存在“一些担忧”，两项存在“高担忧”。所使用的需求评估工具和评估的结果指标存在异质性。在非肿瘤患者中进行护士主导和社会工作者主导试验的研究人员表明，患者生活质量和症状负担有统计学意义的改善。两项试验的研究人员未发现差异，另外两项试验报告生活质量和症状负担有统计学意义不显著的改善。一组研究人员发现6个月时住院情况无差异。没有研究评估住院时间。
关于护士主导的姑息治疗需求评估有效性的高质量证据匮乏。未来的研究人员必须确定何种需求水平预示生活质量差，评估针对当地情况的干预措施，并确定如何使用临床相关结果指标最佳地评估其影响。
