决定姑息性镇静质量的因素是什么?范围审查确定有助于缓和镇静质量的因素。

IF 3.9 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Palliative Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-25 DOI:10.1177/02692163251351534
Indra Albrecht, Joni Gilissen, Lenzo Robijn, Peter Pype, Luc Deliens, Kenneth Chambaere
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引用次数: 0

摘要

背景:姑息性镇静包括使用镇静剂降低意识直至死亡。虽然在临终关怀中很常见,但它仍然很复杂,而且存在争议,质量参数不明确,改进指导也有限。反映姑息性镇静质量的要素的全面概述目前尚不清楚。目的:确定同行评议、索引和灰色文献中报道的姑息性镇静的质量反映因素。设计:使用Levac等人的方法论框架进行范围审查,包括系统搜索、筛选和叙事综合。数据来源:在2023年2月至12月期间,检索具有索引来源的学术数据库(MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO)和同时包含灰色文献的数据库(MEDNAR, Web of Science),查找2009年以后发表的原始数据来源,不受人口或研究设计的限制。结果:在分析的60个来源中,确定了反映姑息性镇静质量的157个要素,并将其分为22个主题和4个总体领域:(1)决策过程要素,如适应证、死亡临近性、时间、患者参与、主动性、患者支持、家庭参与、人工营养和水合作用;(2)表现的过程要素,如镇静水平、药物使用、监测、持续时间、护理延续、家庭支持;(3)结果要素包括患者舒适度、家庭幸福感、家庭满意度、专业人员幸福感和满意度;(4)协作和文档化的过程要素。结论:本综述发现了反映姑息性镇静质量的广泛因素——超出临床表现、镇静结果或患者水平因素。这些见解可以为制定一套核心指标提供信息,以支持姑息性镇静的质量监测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
What determines quality in palliative sedation? A scoping review identifying elements contributing to palliative sedation quality.

Background: Palliative sedation involves using sedatives to reduce consciousness until death. Though common in end-of-life care, it remains complex and controversial, with unclear quality parameters and limited guidance for improvement. A comprehensive overview of elements that reflect quality in palliative sedation is currently missing.

Aim: To identify quality reflecting elements for palliative sedation reported in peer-reviewed, indexed and gray literature.

Design: Scoping review using Levac et al.'s methodological framework, including systematic searching, screening and narrative synthesis.

Data sources: Academic databases with indexed sources (MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO) and databases also containing gray literature (MEDNAR, Web of Science) were searched between February and December 2023 for sources with primary data published after 2009, without restrictions on population or study design.

Results: Among the 60 sources analyzed, 157 elements reflecting palliative sedation quality were identified and thematized into 22 themes and four overarching domains: (1) process elements of decision-making such as indication, proximity to death, timing, patient involvement, proactiveness, patient support, family involvement, artificial nutrition and hydration; (2) process elements of performance, such as level of sedation, medication use, monitoring, duration, care continuation, family support; (3) outcome elements covering patient comfort, family well-being, family satisfaction, professionals' well-being and satisfaction; (4) process elements of collaboration and documentation.

Conclusion: This scoping review found a broad range of elements reflecting palliative sedation quality - beyond clinical performance, sedation outcomes or patient level elements alone. These insights can inform the development of a core set of indicators to support quality monitoring in palliative sedation.

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来源期刊
Palliative Medicine
Palliative Medicine 医学-公共卫生、环境卫生与职业卫生
CiteScore
7.60
自引率
9.10%
发文量
125
审稿时长
6-12 weeks
期刊介绍: Palliative Medicine is a highly ranked, peer reviewed scholarly journal dedicated to improving knowledge and clinical practice in the palliative care of patients with far advanced disease. This outstanding journal features editorials, original papers, review articles, case reports, correspondence and book reviews. Essential reading for all members of the palliative care team. This journal is a member of the Committee on Publication Ethics (COPE).
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