姑息治疗是否能改善不治之症患者的预后?证据的回顾。

Areej El-Jawahri, Joseph A Greer, Jennifer S Temel
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引用次数: 214

摘要

患有不治之症的患者经历了相当大的身体和心理痛苦,这对他们的生活质量产生了负面影响。姑息治疗临床医生主要寻求减轻痛苦,加强应对症状,并使知情决策。在本文中,我们回顾了各种姑息治疗干预措施在改善患者生活质量、身心症状、护理满意度、家庭照顾者结局、卫生服务利用和临终关怀质量方面的疗效。我们已经确定了22个随机研究来评估各种姑息治疗干预措施的疗效。由于疾病进展和死亡导致的耗损和数据缺失,姑息治疗研究一直受到方法学挑战的阻碍。此外,迄今为止的干预措施在服务的重点和范围上差异很大,只有8项研究需要姑息治疗专家的直接临床护理,这使得试验之间的比较具有挑战性。尽管存在这些局限性,但越来越多的证据表明,姑息治疗干预确实改善了患者的生活质量、对护理的满意度和临终结局。将生活质量作为主要结果的七项研究中有五项报告了支持姑息治疗干预的统计显着差异。10项研究调查了患者和/或家庭照顾者对护理的满意度,其中7项研究报告了对姑息治疗干预的更高满意度。然而,缺乏数据支持姑息性干预措施对减轻患者身体和心理症状的益处。我们通过讨论评估和实施标准化姑息治疗干预措施的主要障碍和未来方向来总结综述。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Does palliative care improve outcomes for patients with incurable illness? A review of the evidence.

Patients with incurable illness experience considerable physical and psychological distress, which negatively impacts their quality of life. Palliative care clinicians primarily seek to alleviate suffering, enhance coping with symptoms, and enable informed decision making. In this article, we review the efficacy of various palliative care interventions to improve patients' quality of life, physical and psychological symptoms, satisfaction with care, family caregiver outcomes, health-service utilization, and quality of end-of-life care. We have identified 22 randomized studies that evaluate the efficacy of various palliative care interventions. Palliative care research has been hampered by methodological challenges related to attrition and missing data due to progressive illness and death. In addition, interventions to date have varied widely in the focus and extent of services, with only eight studies entailing direct clinical care by palliative care specialists, making comparisons across trials challenging. Despite these limitations, accumulating evidence shows that palliative care interventions do improve patients' quality of life, satisfaction with care, and end-of-life outcomes. Five of seven studies which examined quality of life as a primary outcome reported a statistically significant difference favoring the palliative care intervention. Ten studies examined patient and/or family caregiver satisfaction with care, and seven of these reported greater satisfaction with palliative care intervention. However, data are lacking to support the benefit of palliative interventions for reducing patients' physical and psychological symptoms. We conclude the review by discussing the major obstacles and future directions in evaluating and implementing standardized palliative care interventions.

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