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。
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
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.