心力衰竭患者居家安宁疗护研究的范围综述

A scoping review of home-based palliative care for heart failure patients

目的对心力衰竭患者居家安宁疗护领域的相关研究进行范围综述,探讨心力衰竭患者居家安宁疗护发展现状,为心力衰竭患者居家安宁疗护的发展提供理论依据。方法系统检索中国知网、维普网、中国生物医学文献数据库、万方数据库、PubMed、Web of Science、Embase、Cochrane Library数据库中与心力衰竭患者居家安宁疗护领域相关的文献,检索时限均为建库至2023年12月31日。对文献进行筛选、数据提取、分析及讨论。结果共纳入19篇文献,包括随机对照试验研究、队列研究、质性研究等,试验研究中心力衰竭患者居家安宁疗护服务的概念框架包括安宁疗护6S模式、过渡护理4C模式、奥马哈系统、慢性病护理模式,服务结构主要是护士主导的多学科团队协作,服务形式主要为家访和电话随访,各研究项目服务频率不固定,服务内容是提供躯体、心理、社会及精神支持,结局指标主要包括患者的再住院率、生活质量、症状负担、成本效益、照顾者负担。队列研究的结局指标主要是患者的治疗偏好及死亡地点。质性研究主要涉及心力衰竭患者、照顾者及医疗服务提供者居家安宁疗护的体验。结论心力衰竭患者居家安宁疗护在实践中产生了积极的效果,建议在规范居家安宁疗护模式的基础上,明确居家安宁疗护患者及家属的需求以及居家安宁疗护发展的障碍及促进因素,推动心力衰竭患者居家安宁疗护的发展。

Objective To conduct a scoping review of research on home-based palliative care for heart failure patients,explore its current development status,and provide a theoretical basis for future advancements in this field.Methods A systematic search was performed in databases including CNKI,VIP,CBMdisc,Wanfang Data,PubMed,Web of Science,Embase,and Cochrane Library for literature related to home-based palliative care for heart failure patients.The search covered publications from the inception of each database until December 31,2023.Literature was screened,and data were extracted,analyzed,and discussed.Results A total of 19 studies were included,including randomized controlled trials,cohort studies,and qualitative research.The conceptual frameworks for home-based palliative care services for heart failure patients in these studies included the 6S model of palliative care,the 4C model of transitional care,the Omaha System,and chronic disease care models.The structure of these services was primarily nurse-led multidisciplinary team collaboration.Service forms included home visits and telephone follow-ups,with varying service frequencies.The content of the services included physical,psychological,social,and spiritual support.Outcome indicators mainly included patient readmission rates,quality of life,symptom burden,cost-effectiveness,and caregiver burden.Cohort study outcomes primarily focused on patient treatment preferences and place of death.Qualitative research explored the experiences of heart failure patients,caregivers,and healthcare providers with home-based palliative care.Conclusions Home-based palliative care for heart failure patients has demonstrated positive effects in practice.It is recommended to standardize home-based palliative care models,clarify the needs of patients and their families,and identify barriers and facilitators to the development of home-based palliative care,thereby promoting its advancement for heart failure patients.