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Advance care planning in the context of clinical deterioration: a systematic review of the literature

机译：临床恶化背景下的预先护理计划：对文献的系统评价

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Background: A Rapid Response Team can respond to critically ill patients in hospital to prevent further deterioration and unexpected deaths. However, approximately one-third of reviews involve a patient approaching the end-of-life. It is not well understood whether patients have pre-existing advance care plans at the time of significant clinical deterioration requiring Rapid Response Team review. Nor is it understood whether such critical events prompt patients, their families and treating teams to discuss advance care planning and consider referral to specialist palliative care services. Aim and design: This systematic review examined advance care planning with patients who experience significant clinical deterioration in hospital and require Rapid Response Team review. The prevalence of pre-existing advance directives, whether this event prompts end-of-life discussions, the provision of broader advance care planning and referral to specialist palliative care services was examined. Data sources: Three electronic databases up to August 2017 were searched, and a manual review of article reference lists conducted. Quality of studies was appraised by the first and fourth authors. Results: Of the 324 articles identified through database searching, 31 met the inclusion criteria, generating data from 47,850 patients. There was a low prevalence of resuscitation orders and formal advance directives prior to Rapid Response Team review, with subsequent increases in resuscitation and limitations of medical treatment orders, but not advance directives. There was high short- and long-term mortality following review, and low rates of palliative care referral. Conclusions: The failure of patients, their families and medical teams to engage in advance care planning may result in inappropriate Rapid Response Team review that is not in line with patient and family priorities and preferences. Earlier engagement in advance care planning may result in improved person-centred care and referral to specialist palliative care services for ongoing management.
机译：背景：快速反应小组可以对医院中的重症患者作出反应，以防止进一步恶化和意外死亡。但是，大约有三分之一的复查涉及患者即将到来。对于严重的临床恶化时需要快速反应小组审查的患者是否具有预先存在的预先护理计划尚不清楚。还不知道这种严重事件是否会促使患者，其家人和治疗团队讨论事先护理计划并考虑转介给专家姑息治疗服务。目的和设计：这项系统的审查针对在医院中出现严重临床恶化并需要快速反应团队审查的患者进行了预先护理计划。审查了预先存在的预先医疗指示的普遍性，此事件是否引发了生命周期讨论，是否提供了更广泛的预先医疗计划以及是否转介了专门的姑息治疗服务。数据来源：检索了截至2017年8月的三个电子数据库，并对文章参考清单进行了人工审核。第一和第四作者对研究质量进行了评估。结果：在通过数据库搜索确定的324篇文章中，有31篇符合纳入标准，从47,850名患者中产生了数据。在快速反应小组进行审查之前，复苏令和正式的预先医疗指示的患病率较低，随后的复苏增加和医疗命令的限制，但事先指示没有。复查后短期和长期死亡率较高，姑息治疗转诊率较低。结论：患者，他们的家庭和医疗团队未能进行预先护理计划可能会导致不正确的快速反应团队审查，这与患者和家庭的优先事项和偏好不符。尽早参与预先护理计划可能会改善以人为本的护理，并转介到专人姑息护理服务以进行持续管理。

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