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护理学报 ›› 2024, Vol. 31 ›› Issue (2): 53-58.doi: 10.16460/j.issn1008-9969.2024.02.053

• 循证护理 • 上一篇    下一篇

终末期患者营养支持决策过程质性研究的Meta整合

李嘉琪1, 叶向红1, 左俊焘1, 徐瑶2, 姚红林1   

  1. 1.南京大学医学院附属金陵医院,江苏 南京 210002;
    2.蚌埠医学院研究生院,安徽 蚌埠 233000
  • 收稿日期:2023-09-04 出版日期:2024-01-25 发布日期:2024-02-20
  • 通讯作者: 叶向红（1965-）,女,江苏南京人,本科学历,主任护师,科护士长。E-mail：icuyz@126.com
  • 作者简介:李嘉琪（1998-）,女,吉林长春人,本科学历,硕士研究生在读。
  • 基金资助:
    军事医学创新工程（18CXZ040）

Qualitative research on nutritional support decision-making process for patients with end-stage disease: a Meta-synthesis

LI Jia-qi1, YE Xiang-hong1, ZUO Jun-tao1, XU Yao2, YAO Hong-lin1   

  1. 1. Jinling Hospital, Affiliated Hospital of Medical School of Nanjing University, Nanjing 210002, China;
    2. Graduate School, Bengbu Medical College, Bengbu 233000, China
  • Received:2023-09-04 Online:2024-01-25 Published:2024-02-20

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摘要： 目的 系统评价终末期患者营养支持决策过程中患者、家属和医护人员的感受,为改善患者及家属决策体验提供新思路。方法 计算机检索Cochrane图书馆、PubMed、Web of Science、Embase、中国知网、万方数据库、维普数据库中有关终末期患者营养支持决策过程、体验的质性研究或混合研究。检索时限为建库至2023年8月。基于JBI循证卫生保健中心推荐的PICoS模型确定文献,采用MAXDQA2022软件对纳入文献进行归类整合。结果 共纳入10篇文献,提炼38个主题,归纳9个类别,最终形成4个整合结果：决策者的多维度思考得出结果;决策者迫切需要专业支持;决策者认知影响决策结果;决策者同样需要心理干预。结论 终末期患者营养支持决策需要经过多方协商、沟通,关注决策者心理体验,必要时给予专业支持,改善患者及家属体验。

关键词: 终末期, 营养支持, 决策, 质性研究, Meta整合, 循证护理学

Abstract: Objective To systematically evaluate the experience of patients with end-stage disease, their families and medical staff during the nutritional support decision-making process and provides new ideas for improving decision-making experience of patients and their families. Methods A computer search was conducted for qualitative or hybrid research on nutritional support decision-making process and experience in Cochrane Library, PubMed, Web of Science, Embase, CNKI, Wanfang and VIP Database. The retrieval period ranged from the inception of the databases to August 2023. The articles were determined based on the PICoS model recommended by the JBI Evidence-based Health Care Center, and the MAXDQA2022 software was used to categorize and integrate the articles. Results A total of ten articles were included in the analysis, resulting in the refinement of 38 themes. These themes were further categorized into nine categories, allowing for the formation of four integrated results: results from multi-dimensional thinking; urgent need for professional support; decisions influenced by decision-makers' cognition, and psychological intervention for decision-makers. Conclusion The nutritional support decision-making for patients with end-stage diseases requires multi-party consultation and communication. The psychological experience of decision-makers should be taken into consideration, and professional support should be provided when needed, thus to improve the experience of patients and their families.

Key words: end stage, nutritional support, decision, qualitative research, Meta-synthesis, evidence-based nursing

中图分类号: 

  • R459.3
[1] Ferrell BR, Temel JS, Temin S, et al.Integration of palliative care into standard oncology care: American society of clinical oncology clinical practice guideline update[J]. J Clin Oncol, 2017, 35(1):96-112.DOI:10.1200/JCO.2016.70.1474.
[2] Orrevall Y, Tishelman C, Permert J, et al.Nutritional support and risk status among cancer patients in palliative home care services[J]. Support Care Cancer, 2009, 17(2):153-161. DOI: 10.1007/s00520-008-0467-4.
[3] Good P, Richard R, Syrmis W, et al. Medically assisted hydration for adult palliative care patients[J]. Cochrane Database Syst Rev, 2014, 2014(4): Cd006273.DOI:10.1002/14651858.
[4] Druml C, Ballmer PE, Druml W, et al.ESPEN guideline on ethical aspects of artificial nutrition and hydration[J]. Clin Nutr, 2016, 35(3):545-556.DOI:10.1016/j.clnu.2016.02.006.
[5] Stern C, Jordan Z, Mcarthur A.Developing the review question and inclusion criteria[J]. Am J Nurs, 2014, 114(4):53-56. DOI: 10.1097/01.NAJ.0000445689.67800.86.
[6] 靳英辉, 高维杰, 李艳, 等. 质性研究证据评价及其循证转化的研究进展[J]. 中国循证医学杂志, 2015,15(12):1458-1464. DOI: 10.7507/1672-2531.20150237.
[7] Colvin CJ, Garside R,Wainwright M,et al.Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 4: how to assess coherence[J]. Implement Sci, 2018, 13(Suppl 1): 13. DOI: 10.1186/s13012-017-0691-8.
[8] Kingdon A, Spathis A, Autunes B, et al.Medical communication and decision-making about assisted hydration in the last days of life: a qualitative study of doctors experienced with end of life care[J]. Palliat Med, 2022, 36(7):1080-1091. DOI: 10.1177/02692163221097309.
[9] Van der riep P, Good P, Higgins I, et al. Palliative care professionals' perceptions of nutrition and hydration at the end of life[J]. Int J Palliat Nurs, 2008, 14(3):145-151. DOI:10.12968/ijpn.2008.14.3.28895.
[10] Cohen MZ, Torres-vigil I, Burbach BE, et al. The meaning of parenteral hydration to family caregivers and patients with advanced cancer receiving hospice care[J]. J Pain Symptom Manage, 2012, 43(5):855-865. DOI:10.1016/j.jpainsymman.2011.06.016.
[11] Rapoport A, Shaheed J, Newman C, et al.Parental perceptions of forgoing artificial nutrition and hydration during end-of-life care[J]. Pediatrics, 2013,131(5):861-869. DOI: 10.1542/peds.2012-1916.
[12] Fournier V, Belghiti E, Brunet L, et al.Withdrawal of artificial nutrition and hydration in neonatal intensive care: parents' and healthcare practitioners' views[J].Med Health Care Philos, 2017, 20(3):365-371. DOI:10.1007/s11019-017-9754-5.
[13] Kitzinger J, Kitzinger C.Deaths after feeding-tube withdrawal from patients in vegetative and minimally conscious states: a qualitative study of family experience[J]. Palliat Med,2018,32(7):1180-1188.DOI:10.1177/0269216318766430.
[14] Firnhaber GC, Roberson DW, Kolasa KM.Nursing staff participation in end-of-life nutrition and hydration decision-making in a nursing home: a qualitative study[J]. J Adv Nurs, 2020,76(11):3059-3068.DOI:10.1111/jan.14491.
[15] Barrado-Martín Y, Nair P, Anantapong K, et al.Family caregivers' and professionals' experiences of supporting people living with dementia's nutrition and hydration needs towards the end of life[J]. Health Soc Care Community, 2022, 30(1):307-318. DOI:10.1111/hsc.13404.
[16] Hochwald IH, Yakov G, Radomyslsky Z, et al.Ethical challenges in end-stage dementia: perspectives of professionals and family care-givers[J]. Nurs Ethics, 2021, 28(7-8): 1228-1243. DOI:10.1177/0969733021999748.
[17] Fairrow AM, Mccallum TJ, Messinger-rapport BJ. Preferences of older African-Americans for long-term tube feeding at the end of life[J]. Aging Ment Health, 2004, 8(6): 530-534. DOI:10.1080/13607860412331303829.
[18] Loofs TS, Haubrick K.End-of-life nutrition considerations: attitudes, beliefs, and outcomes[J].Am J Hosp Palliat Care, 2021, 38(8):1028-1041.DOI:10.1177/1049909120960124.
[19] Amano K, Morita T, Miyamoto J, et al.Perception of need for nutritional support in advanced cancer patients with cachexia: a survey in palliative care settings[J]. Support Care Cancer, 2018,26(8):2793-2799.DOI:10.1007/s00520-018-4104-6.
[20] Regan A, Colling J.Caring for people who are dying: priorities at the end of life[J]. Nurs Stand, 2015,29(24):51-58. DOI: 10.7748/ns.29.24.51.e9710.
[21] Brinkman-Stoppelenburg A, Rietjens JA, Van Der Heide A. The effects of advance care planning on end-of-life care: a systematic review[J]. Palliat Med, 2014, 28(8): 1000-1025. DOI: 10.1177/0269216314526272.
[22] Peacock SC.The experience of providing end-of-life care to a relative with advanced dementia:an integrative literature review[J]. Palliat Support Care, 2013, 11(2):155-168. DOI: 10.1017/S1478951512000831.
[23] 宋静雨,舒瑶雅,王蒙蒙,等.终末期病人配偶照护者需求的Meta整合[J].护理学报, 2021, 28(20):30-38. DOI:10.16460/j.issn1008-9969.2021.20.030.
[24] 李姗姗,黄红艳,李媛媛,等.终末期慢性肾脏病患者治疗决策需求的研究进展[J].护理学报,2023,30(7):38-43. DOI:10.16460/j.issn1008-9969.2023.07.038.
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