严重精神疾病患者的临终关怀:MENLOC证据综合

B. Hannigan, D. Edwards, S. Anstey, M. Coffey, Paul Gill, M. Mann, A. Meudell
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引用次数: 1

摘要

患有严重精神疾病的人有明显的合并症和预期寿命缩短。该项目回答了以下问题:有什么证据表明,对患有严重精神疾病的人进行组织、提供和接受护理,这些人患有晚期无法治愈的癌症和/或终末期肺、心、肾或肝衰竭,并可能在未来12个月内死亡?目标是定位、评价和综合相关研究;查找和综合政策、指导、案例报告和其他灰色和非研究文献;就服务的启用、组织和提供提供提供明确的建议;并为未来的研究提出建议。这种系统的审查和叙述综合遵循国际标准,并由一个咨询小组提供信息,该小组包括具有精神卫生和临终服务经验的人。数据库搜索补充了灰色和非研究文献的搜索。评估相关性和质量,并在叙事综合之前提取数据。综合研究结果的可信度通过推荐、评估、发展和评估的分级和定性研究方法综述证据的可信度来评估。两份综合报告包括104份出版物:34份研究出版物、42份个案研究和28份非研究项目。没有研究因为质量差而被排除在外。研究、政策和指导使用四个主题进行综合:系统结构、专业问题、护理背景和患有严重精神疾病的生活。案例研究综合使用五个主题:诊断延迟和阴影,决策能力和困境,医疗无效,个人和他们的网络,和护理提供。在52个建议、评估、发展和评估分级以及对定性研究总结陈述评论证据的信心方面,有10个获得了高度的信心。根据这些声明,政策、服务和实践方面的影响如下:应在整个系统中利用正式和非正式伙伴关系的机会,并需要找到支持人们在他们选择的地方死亡的方法;在生命末期照顾严重精神疾病患者的工作人员需要教育、支持和监督;在生命末期为患有严重精神疾病的人提供服务需要采用团队方式,包括宣传;及时提供姑息治疗需要对患有严重精神疾病的人进行积极的身体保健。研究建议如下:需要进行面向患者和家庭的研究,以确定在英国背景下帮助和阻碍护理的因素;我们还需要进行研究,共同制定和评估为患有严重精神疾病的人提供和组织临终关怀的新方法,包括那些结构上处于不利地位的人。仅纳入英语项目,无法进行meta分析。计划在该领域开展未来的研究,共同生产和评估护理。本研究注册号为PROSPERO CRD42018108988。该项目由国家卫生研究所(NIHR)卫生和社会保健提供研究方案资助,将全文发表在《卫生和社会保健提供研究》上;第10卷第4期请参阅NIHR期刊图书馆网站了解更多项目信息。
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End-of-life care for people with severe mental illness: the MENLOC evidence synthesis
People with severe mental illness have significant comorbidities and a reduced life expectancy. This project answered the following question: what evidence is there relating to the organisation, provision and receipt of care for people with severe mental illness who have an additional diagnosis of advanced incurable cancer and/or end-stage lung, heart, renal or liver failure and who are likely to die within the next 12 months? The objectives were to locate, appraise and synthesise relevant research; to locate and synthesise policy, guidance, case reports and other grey and non-research literature; to produce outputs with clear implications for service commissioning, organisation and provision; and to make recommendations for future research. This systematic review and narrative synthesis followed international standards and was informed by an advisory group that included people with experience of mental health and end-of-life services. Database searches were supplemented with searches for grey and non-research literature. Relevance and quality were assessed, and data were extracted prior to narrative synthesis. Confidence in synthesised research findings was assessed using the Grading of Recommendations, Assessment, Development and Evaluation and the Confidence in the Evidence from Reviews of Qualitative Research approaches. One hundred and four publications were included in two syntheses: 34 research publications, 42 case studies and 28 non-research items. No research was excluded because of poor quality. Research, policy and guidance were synthesised using four themes: structure of the system, professional issues, contexts of care and living with severe mental illness. Case studies were synthesised using five themes: diagnostic delay and overshadowing, decisional capacity and dilemmas, medical futility, individuals and their networks, and care provision. A high degree of confidence applied to 10 of the 52 Grading of Recommendations, Assessment, Development and Evaluation and Confidence in the Evidence from Reviews of Qualitative Research summary statements. Drawing on these statements, policy, services and practice implications are as follows: formal and informal partnership opportunities should be taken across the whole system, and ways need to be found to support people to die where they choose; staff caring for people with severe mental illness at the end of life need education, support and supervision; services for people with severe mental illness at the end of life necessitate a team approach, including advocacy; and the timely provision of palliative care requires proactive physical health care for people with severe mental illness. Research recommendations are as follows: patient- and family-facing studies are needed to establish the factors helping and hindering care in the UK context; and studies are needed that co-produce and evaluate new ways of providing and organising end-of-life care for people with severe mental illness, including people who are structurally disadvantaged. Only English-language items were included, and a meta-analysis could not be performed. Future research co-producing and evaluating care in this area is planned. This study is registered as PROSPERO CRD42018108988. This project was funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 4. See the NIHR Journals Library website for further project information.
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