肿瘤患者及家属预立医疗照护计划参与经历的Meta整合

Qualitative research on cancer patients and families'experience about Advance Care Planning:a Meta-synthesis

目的:整合肿瘤患者及家属参与预立医疗照护计划(ACP)的体会、感受等的质性研究,为促进ACP临床实施提供参考。方法:检索PubMed、CINAHL、Web of Science、Embase、PsycINFO(Ovid)、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方、维普数据库(VIP)中相关质性研究,检索时间均为从建库至2020年2月。采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准对文献进行质量评价,采取汇集性整合方法进行结果整合。结果:共纳入8项研究,提炼33个研究结果,形成8个类别,得出3个整合结果。整合结果1为肿瘤患者和家属对ACP的接受度;整合结果2为肿瘤患者和家属参与ACP后的感受;整合结果3为肿瘤患者和家属对ACP实施要素的建议。结论:参与ACP的患者和家属心理比较复杂,初期对抗但接受后以积极感受为主。可在全社会范围内加强宣传,提高我国公民对ACP的认知度和接受度。医务人员应进行个体化评估并提供适当的决策辅助模式实施ACP,最终提高肿瘤患者临终生活质量。

Objective:To synthesize qualitative studies on cancer patients and families'experience about Advance Care Planning(ACP),so as to provide references for the clinical implementation of ACP.Methods:We searched databases including PubMed,CINAHL,Web of Science,Embase,PsycINFO(Ovid),CBM,CNKI,Wan Fang Data and VIP from inception to February 2020 to collect qualitative studies on cancer patients and families'experience about ACP.We use JBI Critical Appraisal Checklist for Qualitative Research to evaluate the quality of literature.After quality assessment,Meta-synthesis was used to summarize and explain the results.Results:Eight qualitative studies were included involving 33 results and eight categories.Three integrated themes were extracted:Acceptance of ACP by patients and their families;Feelings of cancer patients and their families towards ACP and Advices for implementation of ACP.Conclusion:There are ambivalent feelings among cancer patients and their families who involved in ACP.Initially they usually confront ACP but have positive feelings after acceptance.The awareness and acceptance of ACP among our citizens could be enhanced by publicity of the whole society.Individualized assessment by medical personnel and appropriate decision aid models to implement ACP should be offered to ultimately improve end-of-life quality of cancer patients.