安宁疗护患者及照顾者居家用药管理体验的Meta整合

Meta-synthesis of home medication management experiences among palliative care patients and caregivers

目的系统评价安宁疗护患者及照顾者居家用药管理体验的质性研究,为改善其药物管理能力,优化基层安宁疗护服务提供参考依据。方法计算机检索Cochrane Library、PubMed、Embase、Web of Science、CINAHL、中国知网、万方数据库、维普数据库、中国生物医学文献数据库,检索安宁疗护患者及照顾者居家用药管理体验的质性研究,检索时限为建库至2024年4月30日。文献质量评价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,并采用汇集性整合方法对结果进行归纳和整合。结果共纳入11篇文献,均为国外文献,提炼出51个结果,归纳为7个新类别,综合为3个整合结果:患者及照顾者居家用药管理的复杂感受:责任与自我效能、焦虑与疲劳;居家药物管理的挑战:多重用药与使用止痛药物体验、居家环境下对于药物管理中的意见分歧、感知基层医疗资源不足;寻求多方面支持:信息获取和用药指导需求、渴望与社区安宁疗护专业人士沟通合作。结论由于复杂用药需求及监管保障不足,居家安宁疗护用药管理具有挑战,建议增强安宁疗护患者及照顾者的自我效能及用药管理能力,提高风险应对水平。同时优化给药流程,加强医护人员的培训,政府机构推动安宁疗护用药政策扶持,为我国安宁疗护患者打造安全、舒适的居家用药环境。

ObjectiveTo systematically review qualitative research on the experiences of palliative care patients and caregivers in home medication management,so as to improve their drug management capabilities and optimize grassroots palliative care services as a reference.MethodsThis review was conducted using databases including the Cochrane Library,PubMed,Embase,Web of Science,CINAHL,China National Knowledge Infrastructure,Wanfang Data,VIP Database,and China Biology Medicine disc,searching for qualitative research on the medication management experiences of palliative care patients and caregivers up to April 30,2024.The quality of the literature was assessed using the Australian Joanna Briggs Institute Evidence-Based Health Care Center standards for qualitative research quality assessment.A convergent integrated approach was employed to synthesize and integrate the findings.ResultsEleven articles were included,all of which were from abroad,synthesizing 51 findings into 7 new categories,which were then integrated into 3 composite outcomes:complex feelings of patients and caregivers in home medication management,including responsibility and self-efficacy,anxiety and fatigue;challenges in home medication management,including polypharmacy and experiences using pain medication,disagreements over medication management at home,and perceived inadequacies in primary healthcare resources;the need for multifaceted support,including desires for more medication guidance and communication with palliative care professionals in the community.ConclusionsDue to the complexity of medication needs and insufficient regulatory support,home medication management in palliative care presents challenges.It is recommended to enhance the self-efficacy and medication management skills of patients and caregivers,improve risk response capabilities,optimize medication administration processes,and strengthen training for healthcare professionals.Government agencies should also support policies to ensure a safe and comfortable home medication environment for palliative care patients in China.