Abstract:

Objective To systematically review the expectation and needs of a good death in patients with end-stage chronic diseases. Methods We searched databases including PubMed,Embase,Web of Science,PsycINFO,Cochrane Library,CNKI,Wanfang,CBM from inception to March 2019. The Joanna Briggs Institute’s Critical Appraisal Tool for qualitative studies was used to evaluate the quality of included studies. The results were synthesized by integrating methods. Results A total of 14 studies were finally included,and 52 results were extracted,and then 4 synthesized results were summarized from the 10 categories. The integrated results were physiological needs（physiological needs at the end-stage,physiological needs at the time of death）,psychological needs（desire fulfillment,positive psychology）,spiritual needs（religious belief,maintenance of dignity,other spiritual needs）,and societal needs（interpersonal,economic,and support systems）. Conclusion The expectation and needs of a good death in patients with end-stage chronic disease involve physiological,psychological,spiritual and societal aspects,with characteristics of individuality and subjectivity,and through the whole process of end-stage. Different expectation and needs may overlap and influence each other. Healthcare providers should pay more attention to patients’ expectation and needs regarding a good death,and provide individualized nursing care for whole human and whole process,as well as spread the knowledge of good death to the public. It is crucial for social resources and health policy to improve the hospice care for those with end-stage chronic diseases.

Key words: Chronic Disease, End-stage, Good Death, Expectation, Need, Qualitative Research, Systematic Review, Hospice Care

摘要：

目的 系统评价慢性病终末期患者优逝期望与需求的质性研究。方法 计算机检索PubMed、Embase、Web of Science、PsycINFO、Cochrane Library、中国知网、万方数据库、中国生物医学文献数据库中从建库至2019年3月31日相关的质性研究。采用澳大利亚JBI循证卫生保健中心质性研究质性评价标准进行文献质量评价,采用汇集性整合方法对研究结果进行归纳整合。结果 共纳入14篇文献,提炼出52个结果,归纳出10个新的类别,综合为4个整合结果：生理需求（临终阶段的生理需求、死亡时的生理需求）;心理需求（满足愿望、积极心理）;精神需求（宗教信仰、维持尊严、其他精神需求）;社会需求（人际关系、经济层面、支持系统）。 结论 慢性病终末期患者的优逝期望与需求涉及生理、心理、精神、社会多个方面,具有个性化、主观性、贯穿终末期全过程的特点,不同方面的期望与需求可能发生重叠并相互影响。医护人员应加强对慢性病终末期患者优逝期望与需求的关注,提供全人、全程的个体化护理服务,普及公众对优逝理念的认识。社会资源及卫生政策应进一步支持安宁疗护事业,共同协助终末期患者实现优逝的愿望。

关键词: 慢性病, 终末期, 优逝, 期望, 需求, 质性研究, 系统评价, 安宁疗护