社区参与安宁疗护对临终期肿瘤患者干预效果的Meta分析  

Efficacy of Community-involved Hospice Care for Patients with Advanced Cancer:a Meta-analysis

作　　者：胡婧伊 洪景 郭晓冬[2] 张晓红 莫宁 周小翠 余钦 周敏华 孙艳 倪柳 石晓丽 苏小青 李玉倩 HU Jingyi;HONG Jing;GUO Xiaodong;ZHANG Xiaohong;MO Ning;ZHOU Xiaocui;YU Qin;ZHOU Minhua;SUN Yan;NI Liu;SHI Xiaoli;SU Xiaoqing;LI Yuqian(Traditional Chinese Medicine Department,Gaojing Town Community Health Center,Baoshan District,Shanghai 200439,China;Oncology DepartmentⅡ,Yueyang Hospital of Intergrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海市宝山区高境镇卫生服务中心中医科,200439 [2]上海中医药大学附属岳阳中西医结合医院肿瘤二科,上海市200437

出　　处：《中国全科医学》2023年第28期3573-3584,共12页Chinese General Practice

基　　金：上海市宝山区科委课题项目(20-E-50)。

摘　　要：背景社区干预是临终期肿瘤患者安宁疗护的重要组成部分,其在临终期肿瘤患者健康管理中的作用尚有待循证医学证据的支持。目的评价社区参与安宁疗护对临终期肿瘤患者的干预效果。方法于2022-05-22,采用Cochrane系统评价方法,以“社区”“医疗模式”“临终期肿瘤”等为检索词检索万方数据知识服务平台、中国知网、维普网,以“Community-based”“Model of Palliative Care”“Advanced Cancer”“Quality of Life”等为检索词检索Cochrane Library、PubMed、Web of Science,以获取和社区参与安宁疗护干预效果相关的文献,研究类型设定为随机对照试验(RCT),检索时限设定为2007-01-01至2022-05-10。对符合纳入标准的RCT进行质量评价,提取有效信息进行Meta分析。结果共纳入11项英文RCT(涉及患者2356例),9项中文RCT(涉及患者1238例)。Meta分析结果显示:与常规肿瘤护理相比,社区参与的安宁疗护能够改善临终期肿瘤患者的生活质量和症状严重程度,其可提高患者的慢性病支持治疗功能评价量表得分〔MD(95%CI)=3.77(0.83,6.71),P=0.01〕、癌症患者生命质量测定量表总分〔MD(95%CI)=12.53(2.36,22.69),P=0.02〕,降低患者的癌症治疗功能评价量表总分〔MD(95%CI)=-2.61(-3.53,-1.70),P<0.01〕、埃德蒙顿量表得分〔MD(95%CI)=-2.45(-4.70,-0.20),P=0.03〕。但是否能改善患者的抑郁症状、总体生存率存在争议,而对于入院率、住院天数/次数等经济学指标的作用有待进一步研究。结论社区参与的安宁疗护可以改善临终期肿瘤患者的生活质量和症状严重程度,但在改善抑郁、提高生存率、降低医疗成本方面的作用有待进一步研究。Background Community-based intervention is an important part of palliative care for advanced cancer patients.However,its role in the health management of advanced cancer patients remains to be supported by medical evidence.Objective To evaluate the efficacy of community-involved hospice care for patients with advanced cancer.Methods Wanfang Data Knowledge Service Platform,CNKI,VIP were searched by using Chinese keywords such as"community""medical model"and"advanced cancer",Cochrane Library,PubMed and Web of Science were searched by using English keywords such as"Community-based""Model of Palliative Care""Advanced Cancer""Quality of Life",to obtain randomized controlled trials(RCTs)related to the efficacy of community-involved hospice care from 2007-01-01 to 2022-05-10 by using Cochrane system evaluation method on 2022-05-22.The quality of RCTs meeting the inclusion criteria was evaluated,and the valid information was extracted for meta-analysis.Results A total of 11 RCTs in English and 9 RCTs in Chinese were included in the study,involving 2356 and 1238 patients,respectively.Meta-analysis showed that compared with routine cancer care,community-involved hospice care could improve quality of life and symptom severity in patients with advanced cancer,demonstrated by increasing Functional Assessment of Chronic Illness Therapy-Palliative Care scale socre〔MD(95%CI)=3.77(0.83,6.71),P=0.01〕and Quality of Life Instruments for Cancer Patients scale total score〔MD(95%CI)=12.53(2.36,22.69),P=0.02〕,reducing Functional Assessment of Cancer Therapy scale total score〔MD(95%CI)=-2.61(-3.53,-1.70),P<0.01〕and Edmonton Symptom Assessment System score〔MD(95%CI)=-2.45(-4.70,-0.20),P=0.03〕.However,the improvement of community-involved hospice care on depressive symptoms and overall survival rates of patients remains controversial,and its effect on economic indicators such as admission rates,hospitalization days/numbers needs to be further explored.Conclusion Community-involved hospice care can improve the quality of lif

关 键 词：临终关怀和姑息治疗护理 肿瘤护理 临终期肿瘤 社区卫生服务 干预效果 生活质量 META分析 

分 类 号：R473.51[医药卫生—护理学]