痴呆患者及家属参与预立医疗照护计划体验的Meta整合

doi:10.3761/j.issn.0254-1769.2021.12.019

摘要/Abstract

摘要：

目的系统评价痴呆患者及家属参与预立医疗照护计划（advance care planning,ACP）体验的质性研究,为ACP在痴呆患者及家属中的应用提供参考依据。方法计算机检索Web of Science、PubMed、EBSCO、The Cochrane Library、EmBase、中国知网、中国生物医学文献数据库、万方等中英文数据库中关于痴呆患者及家属参与ACP体验的相关质性研究,检索时限从建库至2021年8月,根据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,运用Meta整合方法对研究结果进行整合。结果共纳入11篇文献,提炼出41个明确的研究结果,归纳组合相近的研究结果形成9个类别,进一步综合得到4个整合结果：痴呆患者及家属参与ACP的态度、痴呆患者及家属参与ACP的感知益处、痴呆患者及家属参与ACP的感知障碍、痴呆患者及家属参与ACP的反应。结论在ACP的实施过程中需要关注痴呆患者及家属对ACP的态度变化,帮助其提高对ACP的接受度,同时可以通过减轻家属参与ACP的负面影响,促进痴呆患者的偏好表达,丰富ACP的内容和干预形式,促进ACP的发展与完善。

关键词: 预立医疗照护计划, 痴呆, 体验, 质性研究, Meta整合, 系统评价, 护理

Abstract:

Objective To conduct a meta-synthesis of the experience of dementia patients and their relatives in advance care planning（ACP） and provide evidence-based guidance for the development and implementation of ACP in dementia patients. Methods 8 databases（Web of science,PubMed,EBSCO,The Cochrane Library,Embase,CNKI,CBM,Wan Fang） were included to retrieve the literature on the experience of dementia patients and their relatives about ACP intervention from inception until August 2021. The quality of included studies was evaluated according to JBI Critical Appraisal Tool for qualitative studies in Australia. Meta-aggregation was used to conduct the synthesis. Results 41 findings were extracted from 11 qualified studies and they were integrated into 9 categories. 4 synthesis results were summarized,including attitude of dementia patients and their families to participate in ACP,the perceived benefits of dementia patients and their families to participate in ACP,the perceived barriers of dementia patients and their families to participate in ACP,and the perceived reactions of dementia patients and their families to participate in ACP. Conclusion The successful implementation of ACP requires continuous focus on the attitude of dementia patients and their families for participation. At the same time,facing the difficulties of dementia patients participating in ACP,we should alleviate the negative influence of family members’ participation and attach importance to patient preferences and enrich the content and form of ACP to promote the development and improvement of ACP.

Key words: Advance Care Planning, Dementia, Experience, Qualitative Research, Meta-Synthesis, Systematic Review, Nursing Care

张玲利, 刘东玲, 王子辰, 李嘉音, 刘雪冰, 张琼文. 痴呆患者及家属参与预立医疗照护计划体验的Meta整合[J]. 中华护理杂志, 2021, 56(12): 1876-1882.

ZHANG Lingli, LIU Dongling, WANG Zichen, LI Jiayin, LIU Xuebing, ZHANG Qiongwen. The experience of dementia patients and their relatives in advance care planning：a meta-synthesis of qualitative research[J]. Chinese Journal of Nursing, 2021, 56(12): 1876-1882.

图/表 5

图1 PubMed检索策略

Figure 1 PubMed search string

图2 文献检索及筛选流程

Figure 2 Literature retrieval and screening process

表1 纳入文献的方法学质量评价结果

Tab.1 Methodological quality evaluation of included literatures

表2 纳入文献的资料提取结果

Tab.2 Information of included studies

图3 整合结果结构图注：ACP为预立医疗照护计划。

Figure3 Structure diagram of integration result

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