不同照护者视角下实施居家安宁疗护阻碍因素质性研究的Meta整合

Barriers of home-based hospice care from different caregiver perspectives:a Meta-synthesis of qualitative research

目的系统评价专业照护者和家庭照护者两种不同视角下实施居家安宁疗护的体验,归纳照护者面临的阻碍因素。方法本研究为Meta整合。计算机检索中国知网、万方数据库、维普网、PubMed、Web of Science、Cochrane Library、Embase、CINAHL、Medline数据库中关于专业照护者或家庭照护者实施居家安宁疗护障碍体验的质性研究。检索时限从建库至2023年10月3日。采用澳大利亚乔安娜布里格斯研究所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,利用汇集性Meta整合方法对纳入文献进行整合。结果共纳入10篇文献,质量评价等级均为B级。共提炼出35个结果,归纳形成8个新类别。最终形成患者家属实施居家安宁疗护的阻碍因素(3个类别)、专业照护者实施居家安宁疗护的阻碍因素(5个类别)2个整合结果。结论受外部政策、组织及人员因素等多方面的影响,居家安宁疗护服务的实践发展仍存在很多挑战。政府及医疗机构可针对不同照护者实施居家安宁疗护的阻碍因素制定或完善有关政策及服务流程,促进居家安宁疗护的发展。

Objective To systematically evaluate the experience of home-based hospice care from two different perspectives of professional caregivers and family caregivers,and summarize the barriers faced by caregivers.Methods This study was Meta-synthesis.Qualitative studies on the barriers of home-based hospice care among professional caregivers or family caregivers were electronically searched on China National Knowledge Infrastructure,WanFang Data,VIP,PubMed,Web of Science,Cochrane Library,Embase,CINAHL and Medline.The search period was from database establishment to October 3,2023.The quality evaluation of literature was conducted using the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center.The aggregation Meta-synthesis method was used to integrate the included article.Results A total of ten articles were included,all had a quality evaluation level of B.Thirty-five results were extracted and summarized into eight new categories.Two integrated results were formed,including barriers to implementation of home-based hospice care by patients'family members(three categories)and barriers to implementation of home-based hospice care by professional caregivers(five categories).Conclusions Due to various factors such as external policies,organizations,and personnel,there are still many challenges in the practical development of home-based hospice care.Government and medical institutions can formulate or improve policies and service processes to address the obstacles to implementing home hospice care for different caregivers,and promote the development of home-based hospice care.