A systematic review of the integration of palliative care in dementia management

H. Senderovich, Sivarajini Retnasothie
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引用次数: 12

Abstract

Abstract Objective Dementia is a progressive illness with a complex biopsychosocial constellation of symptoms faced by millions of individuals and families worldwide. Palliative care teams have specialized in symptom management and end-of-life care for decades; however, the role of palliative care in dementia management is not yet well elucidated. The aim of this systematic review was to understand the impact of palliative care in dementia management. Method This systematic review was conducted using a prospective study protocol. Medline and PubMed were searched from January 1, 1998 to October 2017. Eligible studies included single-blind cluster, two-arm parallel cluster, or unblinded randomized controlled trials (RCTs), observational studies, retrospective cohort studies, cross-sectional studies, concurrent mixed methods study, qualitative study, and Delphi studies. Results Four key themes were identified in this review: goals of care and end-of-life conversations, symptom management, emergency room visits, and prescribing behavior. In each domain, palliative care consultation either showed benefit or was postulated to have benefit if implemented. Significance of results Although the literature to support or refute thematic conclusions is not large, there was a trend toward patient care benefit across several domains. Large RCTs with longer follow-up across different settings should be undertaken to solidify the themes and trends outlined in this review. Understanding the views of healthcare providers including referral sources (i.e., general practitioners and specialists) through qualitative research could optimize palliative care referrals, implement palliative care recommendations, and improve a targeted palliative care education curriculum.
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综合姑息治疗在痴呆管理中的系统回顾
摘要目的痴呆症是一种进行性疾病,具有复杂的生物、心理和社会症状,全世界数百万个人和家庭都面临着这种疾病。几十年来,姑息治疗团队专门从事症状管理和临终关怀;然而,姑息治疗在痴呆症管理中的作用尚未得到很好的阐明。本系统综述的目的是了解姑息治疗对痴呆管理的影响。方法采用前瞻性研究方案进行系统评价。检索自1998年1月1日至2017年10月的Medline和PubMed。符合条件的研究包括单盲集群、双臂平行集群或非盲随机对照试验(rct)、观察性研究、回顾性队列研究、横断面研究、并发混合方法研究、定性研究和德尔菲研究。结果本综述确定了四个关键主题:护理目标和临终对话、症状管理、急诊室就诊和处方行为。在每个领域,姑息治疗咨询要么显示效益或假设有效益,如果实施。虽然支持或反驳专题结论的文献并不多,但在多个领域都有患者护理受益的趋势。应该进行大型随机对照试验,在不同的环境中进行较长的随访,以巩固本综述中概述的主题和趋势。通过定性研究了解包括转诊来源(即全科医生和专科医生)在内的医疗服务提供者的观点,可以优化姑息治疗转诊,实施姑息治疗建议,并改进有针对性的姑息治疗教育课程。
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