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非癌症患者接受姑息治疗可降低急诊使用率
作者:小柯机器人 发布时间:2020/10/17 22:44:52

加拿大多伦多大学Chaim M. Bell团队研究了成人慢性非癌症疾病患者接受姑息性护理干预与卫生保健使用、生活质量和症状负担的相关性。2020年10月13日,《美国医学会杂志》发表了该成果。

姑息治疗主要用于癌症患者。姑息治疗对非癌性疾病患者生命预后的影响尚不清楚。

为了评估姑息治疗与急诊医疗保健使用、生活质量(QOL)和慢性非癌症成年人症状负担之间的相关性,研究组从MEDLINE、Embase、CINAHL、PsycINFO和PubMed等大型数据库中检索从建库到2020年4月18日的文献,筛选出成人慢性非癌性疾病姑息治疗干预的随机临床试验。排除了涉及至少50%癌症患者的研究。

研究组共纳入28项试验,涉及13664例患者的数据,平均年龄为74岁,女性占46%。其中10项试验为心力衰竭患者(4068例),11项为混合疾病患者(8119例),4项为痴呆症患者(1036例),3项为慢性阻塞性肺疾病患者(441例)。姑息治疗的患者急诊使用率为20%,低于常规治疗组(24%);平均住院率为38%,低于常规治疗组(42%);疾病症状负担也略低于常规治疗组。姑息治疗与常规治疗相比,一般性疾病或特定疾病的生活质量无显著差异。

研究结果表明,对于非癌症患者,与常规治疗相比,姑息治疗可显著降低急诊使用率和症状负担,但生活质量无显著差异。

附:英文原文

Title: Association of Receipt of Palliative Care Interventions With Health Care Use, Quality of Life, and Symptom Burden Among Adults With Chronic Noncancer Illness: A Systematic Review and Meta-analysis

Author: Kieran L. Quinn, Mohammed Shurrab, Kevin Gitau, Dio Kavalieratos, Sarina R. Isenberg, Nathan M. Stall, Therese A. Stukel, Russell Goldman, Daphne Horn, Peter Cram, Allan S. Detsky, Chaim M. Bell

Issue&Volume: 2020/10/13

Abstract:

Importance  The evidence for palliative care exists predominantly for patients with cancer. The effect of palliative care on important end-of-life outcomes in patients with noncancer illness is unclear.

Objective  To measure the association between palliative care and acute health care use, quality of life (QOL), and symptom burden in adults with chronic noncancer illnesses.

Data Sources  MEDLINE, Embase, CINAHL, PsycINFO, and PubMed from inception to April 18, 2020.

Study Selection  Randomized clinical trials of palliative care interventions in adults with chronic noncancer illness. Studies involving at least 50% of patients with cancer were excluded.

Data Extraction and Synthesis  Two reviewers independently screened, selected, and extracted data from studies. Narrative synthesis was conducted for all trials. All outcomes were analyzed using random-effects meta-analysis.

Main Outcomes and Measures  Acute health care use (hospitalizations and emergency department use), disease-generic and disease-specific quality of life (QOL), and symptoms, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy-Palliative Care scale (range, 0 [worst] to 184 [best]; minimal clinically important difference, 9 points) and symptoms translated to units of the Edmonton Symptom Assessment Scale global distress score (range, 0 [best] to 90 [worst]; minimal clinically important difference, 5.7 points).

Results  Twenty-eight trials provided data on 13664 patients (mean age, 74 years; 46% were women). Ten trials were of heart failure (n=4068 patients), 11 of mixed disease (n=8119), 4 of dementia (n=1036), and 3 of chronic obstructive pulmonary disease (n=441). Palliative care, compared with usual care, was statistically significantly associated with less emergency department use (9 trials [n=2712]; 20% vs 24%; odds ratio, 0.82 [95% CI, 0.68-1.00]; I2=3%), less hospitalization (14 trials [n=3706]; 38% vs 42%; odds ratio, 0.80 [95% CI, 0.65-0.99]; I2=41%), and modestly lower symptom burden (11 trials [n = 2598]; pooled standardized mean difference (SMD), 0.12; [95% CI, 0.20 to 0.03]; I2=0%; Edmonton Symptom Assessment Scale score mean difference, 1.6 [95% CI, 2.6 to 0.4]). Palliative care was not significantly associated with disease-generic QOL (6 trials [n=1334]; SMD, 0.18 [95% CI, 0.24 to 0.61]; I2=87%; Functional Assessment of Chronic Illness Therapy-Palliative Care score mean difference, 4.7 [95% CI, 6.3 to 15.9]) or disease-specific measures of QOL (11 trials [n=2204]; SMD, 0.07 [95% CI, 0.09 to 0.23]; I2=68%).

Conclusions and Relevance  In this systematic review and meta-analysis of randomized clinical trials of patients with primarily noncancer illness, palliative care, compared with usual care, was statistically significantly associated with less acute health care use and modestly lower symptom burden, but there was no significant difference in quality of life. Analyses for some outcomes were based predominantly on studies of patients with heart failure, which may limit generalizability to other chronic illnesses.

DOI: 10.1001/jama.2020.14205

Source: https://jamanetwork.com/journals/jama/article-abstract/2771606

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex