安宁疗护咨询在癌症患者中应用的范围综述

Application of hospice care consultation in cancer patients:a scoping review

目的综述安宁疗护咨询在癌症患者中的应用情况,为今后制订癌症患者安宁疗护咨询方案提供参考。方法在明确研究问题后,检索Cochrane Library、PubMed、CINAHL、Embase、Web of Science、中国知网、万方、维普、中国生物医学文献服务系统数据库中有关癌症患者安宁疗护咨询的相关文献,检索时间为建库至2023年5月。按照纳入和排除标准筛选文献,并对纳入的文献进行内容提取、汇总和分析。结果共检索到相关文献12572篇,经筛选后最终纳入文献18篇,包括12篇回顾性研究、3篇描述性研究、3篇前瞻性研究。是否接受癌症患者的安宁疗护咨询由主治医生判断、触发工具评估及患者主动请求;咨询时机较晚,一般发生在临终前1~3个月。在咨询过程中每例患者约涉及4~8个癌症相关症状,咨询地点大多在住院病房,其次为门诊。安宁疗护咨询能够提高安宁疗护转诊率,降低非计划入院率、重症监护室入住率等。然而,由于存在患者、医务人员及缺乏触发标准等3个方面阻碍因素,导致癌症患者存在较多未满足的安宁疗护需求。结论癌症患者的安宁疗护咨询触发标准缺乏特异性,咨询时机较晚,咨询过程有待进一步探究。未来应进一步开展多学科合作的随机对照试验或前瞻性研究,探讨癌症患者安宁疗护咨询的最佳时机,依据不同癌症类型制订相应的触发标准和咨询过程。

Objective To conduct a scoping review on the application of hospice counseling in cancer patients,and provide a reference for developing the hospice counseling programs for cancer patients.Methods We systematically searched the literature on palliative care counseling for cancer patients in Cochrane Library,PubMed,CINAHL,Embase,Web of Science,CNKI,Wanfang,and CBM databases after clarifying the research question.The search period was from the establishment of the database to May 2023.Then we selected literature according to inclusion and exclusion criteria,and extracted,summarized,and analyzed the content of the included literature.Results A total of 12,572 relevant papers were searched,and 18 of them were finally included,including 12 retrospective studies,three descriptive studies,and three prospective studies.Hospice consultation for cancer patients is carried out by the judgment of the attending physician,triggered tools assessment and the patient’s active request.The consultation time generally occurred within 1-3 months before end-of-life.About 4-8 cancer-related symptoms are involved in the consultation process,and the consultation location is mostly conducted in hospital wards followed by outpatient settings.Palliative care consultations can increase referral rates for palliative care while reducing unplanned hospital admissions,intensive care unit occupancy rates,and among others.However,due to barriers from patients,healthcare professionals,and a lack of triggering criteria,many unmet palliative needs exist among cancer patients.Conclusion The trigger criteria for hospice consultation for cancer patients lacks specificity,the timing of counseling is often delayed,and the counseling process needs to be further explored.In the future,further multidisciplinary randomized controlled trials or prospective studies should be conducted to explore the optimal timing of hospice consultation for patients,and to develop appropriate triggering criteria and counseling processes based on different cancer types.