Sophie Pask, Chukwuebuka Okwuosa, Ahmed Mohamed, Rebecca Price, Jennifer Young, Thomas Curtis, Stuart Henderson, Ishbel Winter-Luke, Anisha Sunny, Rachel L Chambers, Sarah Greenley, Therese Johansson, Anna E Bone, Stephen Barclay, Irene J Higginson, Katherine E Sleeman, Fliss Em Murtagh
{"title":"为在家生活的成年人提供姑息治疗和临终关怀的模式、组成部分和结果：综述的系统总括性综述。","authors":"Sophie Pask, Chukwuebuka Okwuosa, Ahmed Mohamed, Rebecca Price, Jennifer Young, Thomas Curtis, Stuart Henderson, Ishbel Winter-Luke, Anisha Sunny, Rachel L Chambers, Sarah Greenley, Therese Johansson, Anna E Bone, Stephen Barclay, Irene J Higginson, Katherine E Sleeman, Fliss Em Murtagh","doi":"10.1177/02692163251362567","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There is growing demand for home-based palliative care because of patient preference, and increased number of deaths. Optimal models for community-based palliative and end-of-life care are unknown.</p><p><strong>Aim: </strong>To identify, synthesise and describe review-level evidence to better understand models of palliative and end-of-life care for adults living at home, and examine components of these models and their association with outcomes.</p><p><strong>Design: </strong>Systematic umbrella review, using key concepts established a priori from Firth et al. and Brereton et al.''s model descriptions. Quality assessment used AMSTAR-2 or equivalent.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, CINAHL, Cochrane Database, Epistemonikos (inception - 2024), supplemented by CareSearch, PROSPERO and citation searches.</p><p><strong>Results: </strong>From 6683 initial papers, <i>n</i> = 66 reviews were included. Seven models of care were identified; by setting (in-home, outpatient); type of professionals (specialist, integrated, non-specialist); or mode (telehealth, education/training). 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Components included: holistic person-centred assessment, skilled professionals, access to medicines/care/equipment, patient/family support, advance care planning, integration of services, virtual/remote technology and education. We categorised outcomes into: (i) patient outcomes, (ii) family/informal caregiver outcomes, (iii) professional outcomes and iv) service utilisation/cost outcomes. The 'in-home palliative care' model was most researched with good evidence of positive benefit. Specialist and integrated models of care were next most researched, with evidence of improved patient and service utilisation outcomes. Cost-effectiveness evidence was lacking.</p><p><strong>Conclusion: </strong>This meta-level evidence supports provision of in-home palliative care, with most review level evidence showing positive effect on patient outcomes. 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引用次数: 0
摘要
背景：由于患者的偏好和死亡人数的增加，对以家庭为基础的姑息治疗的需求不断增长。以社区为基础的姑息治疗和临终关怀的最佳模式尚不清楚。目的：识别、综合和描述综述级证据，以更好地理解在家生活的成年人的姑息治疗和临终关怀模型，并检查这些模型的组成部分及其与结果的关联。设计：使用Firth et al.和breereton et al.的模型描述中先验建立的关键概念进行系统的伞形回顾。质量评估采用AMSTAR-2或同等标准。数据来源：MEDLINE， EMBASE， CINAHL, Cochrane Database, Epistemonikos (inception - 2024)，辅以CareSearch， PROSPERO和引文搜索。结果：从6683篇初始论文中，纳入了n = 66篇综述。确定了七种护理模式；通过设置（在家，门诊）；专业人员类型（专科、综合、非专科）；或模式（远程医疗、教育/培训）。组成部分包括：以人为本的全面评估、熟练的专业人员、获得药品/护理/设备、病人/家属支持、预先护理规划、综合服务、虚拟/远程技术和教育。我们将结果分为：(i)患者结果，（ii）家庭/非正式照顾者结果，（iii）专业结果和（iv）服务利用/成本结果。“家庭姑息治疗”模式的研究最多，有充分的证据表明其积极的益处。专家和综合护理模式是下一个研究最多的，有证据表明，改善了患者和服务的利用结果。缺乏成本效益证据。结论：这一荟萃水平的证据支持提供家庭姑息治疗，大多数回顾水平的证据显示对患者预后有积极影响。也有证据支持专科姑息治疗和初级姑息治疗与专科支持的整合。
Models, components and outcomes of palliative and end-of-life care provided to adults living at home: A systematic umbrella review of reviews.
Background: There is growing demand for home-based palliative care because of patient preference, and increased number of deaths. Optimal models for community-based palliative and end-of-life care are unknown.
Aim: To identify, synthesise and describe review-level evidence to better understand models of palliative and end-of-life care for adults living at home, and examine components of these models and their association with outcomes.
Design: Systematic umbrella review, using key concepts established a priori from Firth et al. and Brereton et al.''s model descriptions. Quality assessment used AMSTAR-2 or equivalent.
Data sources: MEDLINE, EMBASE, CINAHL, Cochrane Database, Epistemonikos (inception - 2024), supplemented by CareSearch, PROSPERO and citation searches.
Results: From 6683 initial papers, n = 66 reviews were included. Seven models of care were identified; by setting (in-home, outpatient); type of professionals (specialist, integrated, non-specialist); or mode (telehealth, education/training). Components included: holistic person-centred assessment, skilled professionals, access to medicines/care/equipment, patient/family support, advance care planning, integration of services, virtual/remote technology and education. We categorised outcomes into: (i) patient outcomes, (ii) family/informal caregiver outcomes, (iii) professional outcomes and iv) service utilisation/cost outcomes. The 'in-home palliative care' model was most researched with good evidence of positive benefit. Specialist and integrated models of care were next most researched, with evidence of improved patient and service utilisation outcomes. Cost-effectiveness evidence was lacking.
Conclusion: This meta-level evidence supports provision of in-home palliative care, with most review level evidence showing positive effect on patient outcomes. There was also evidence to support specialist palliative care and integration of primary palliative care with specialist support.
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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