Dilantha Dharmagunawardene MD, Sanjeewa Kularatna PhD, Ureni Halahakone MHM, Louise Purtell PhD, Ann Bonner PhD, Helen G. Healy PhD, Sameera Senanayake PhD
{"title":"成人慢性肾病的卫生系统相关肾脏支持护理干预：系统综述。","authors":"Dilantha Dharmagunawardene MD, Sanjeewa Kularatna PhD, Ureni Halahakone MHM, Louise Purtell PhD, Ann Bonner PhD, Helen G. Healy PhD, Sameera Senanayake PhD","doi":"10.1111/jorc.12517","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Kidney failure can be managed either conservatively or via kidney replacement therapy. Kidney supportive care combines the expertise of nephrology with palliative care in a multidisciplinary team with a focus on improving quality of life.</p>\n </section>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>To identify and appraise evidence-based health system kidney supportive care interventions</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>Systematic review (PROSPERO Registration - CRD42022333650).</p>\n </section>\n \n <section>\n \n <h3> Participants</h3>\n \n <p>Adults with chronic kidney failure.</p>\n </section>\n \n <section>\n \n <h3> Measurements</h3>\n \n <p>Six databases were searched, using terms “palliative care” and “chronic kidney disease” for publications between January 2010 and March 2024. The Cochrane “Effective Practice and Organisation of Care” and “Clinical Practice Guidelines for Quality Palliative Care” domains informed data extraction.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of the 60 studies included, one-third were randomised controlled trials. The most common “Effective Practice and Organisation of Care” domain described was care delivery (58/60). End-of-life care (33/60), and physical aspects of care (19/60), were commonly described “Clinical Practice Guidelines for Quality Palliative Care” domains. Multidisciplinary shared care was highlighted in 26 studies. Least described domains were cultural (0/60) and ethical aspects (3/60). Almost 2/3 (39/60) of studies compared the outcomes of kidney supportive care interventions, and the most common outcome assessed was advance care planning (18/39). Key findings reported integrated palliative care reduced hospital admissions and costs, facilitated better patient-clinician communication, and improved symptom management. Gaps were identified in cultural and ethical/legal aspects of care.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The studies highlighted the effectiveness of kidney-supportive care interventions in improving patient outcomes, especially in end-of-life care and symptom management. However, significant existing gaps identified necessitate further research.</p>\n </section>\n </div>","PeriodicalId":16947,"journal":{"name":"Journal of renal care","volume":"51 1","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Health system related kidney supportive care interventions for adults with chronic kidney disease: A systematic review\",\"authors\":\"Dilantha Dharmagunawardene MD, Sanjeewa Kularatna PhD, Ureni Halahakone MHM, Louise Purtell PhD, Ann Bonner PhD, Helen G. Healy PhD, Sameera Senanayake PhD\",\"doi\":\"10.1111/jorc.12517\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>Kidney failure can be managed either conservatively or via kidney replacement therapy. Kidney supportive care combines the expertise of nephrology with palliative care in a multidisciplinary team with a focus on improving quality of life.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>To identify and appraise evidence-based health system kidney supportive care interventions</p>\\n </section>\\n \\n <section>\\n \\n <h3> Design</h3>\\n \\n <p>Systematic review (PROSPERO Registration - CRD42022333650).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Participants</h3>\\n \\n <p>Adults with chronic kidney failure.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Measurements</h3>\\n \\n <p>Six databases were searched, using terms “palliative care” and “chronic kidney disease” for publications between January 2010 and March 2024. 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Health system related kidney supportive care interventions for adults with chronic kidney disease: A systematic review
Introduction
Kidney failure can be managed either conservatively or via kidney replacement therapy. Kidney supportive care combines the expertise of nephrology with palliative care in a multidisciplinary team with a focus on improving quality of life.
Objective
To identify and appraise evidence-based health system kidney supportive care interventions
Six databases were searched, using terms “palliative care” and “chronic kidney disease” for publications between January 2010 and March 2024. The Cochrane “Effective Practice and Organisation of Care” and “Clinical Practice Guidelines for Quality Palliative Care” domains informed data extraction.
Results
Of the 60 studies included, one-third were randomised controlled trials. The most common “Effective Practice and Organisation of Care” domain described was care delivery (58/60). End-of-life care (33/60), and physical aspects of care (19/60), were commonly described “Clinical Practice Guidelines for Quality Palliative Care” domains. Multidisciplinary shared care was highlighted in 26 studies. Least described domains were cultural (0/60) and ethical aspects (3/60). Almost 2/3 (39/60) of studies compared the outcomes of kidney supportive care interventions, and the most common outcome assessed was advance care planning (18/39). Key findings reported integrated palliative care reduced hospital admissions and costs, facilitated better patient-clinician communication, and improved symptom management. Gaps were identified in cultural and ethical/legal aspects of care.
Conclusions
The studies highlighted the effectiveness of kidney-supportive care interventions in improving patient outcomes, especially in end-of-life care and symptom management. However, significant existing gaps identified necessitate further research.
期刊介绍：
The Journal of Renal Care (JORC), formally EDTNA/ERCA Journal, is the official publication of the European Dialysis and Transplant Nursing Association/European Renal Care Association (EDTNA/ERCA).
The Journal of Renal Care is an international peer-reviewed journal for the multi-professional health care team caring for people with kidney disease and those who research this specialised area of health care. Kidney disease is a chronic illness with four basic treatments: haemodialysis, peritoneal dialysis conservative management and transplantation, which includes emptive transplantation, living donor & cadavaric transplantation. The continuous world-wide increase of people with chronic kidney disease (CKD) means that research and shared knowledge into the causes and treatment is vital to delay the progression of CKD and to improve treatments and the care given.
The Journal of Renal Care is an important journal for all health-care professionals working in this and associated conditions, such as diabetes and cardio-vascular disease amongst others. It covers the trajectory of the disease from the first diagnosis to palliative care and includes acute renal injury. The Journal of Renal Care accepts that kidney disease affects not only the patients but also their families and significant others and provides a forum for both the psycho-social and physiological aspects of the disease.
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