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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >What accounts for differences or disparities in pediatric palliative and end-of-life care? A systematic review focusing on possible multilevel mechanisms.
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What accounts for differences or disparities in pediatric palliative and end-of-life care? A systematic review focusing on possible multilevel mechanisms.

机译：是什么导致儿科姑息治疗和临终护理的差异或差异？着重于可能的多级机制的系统审查。

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OBJECTIVE: The goal was to clarify potential mechanisms underlying differences/disparities in pediatric palliative and end-of-life care. METHODS: We systematically searched online databases to identify articles relating to differences/disparities in pediatric palliative and end-of-life care, retaining 19 studies for evaluation. We then augmented this search with a broader review of the literature on the mechanisms of differences/disparities in adult palliative and end-of-life care, general pediatrics, adult medicine, and pain. RESULTS: The concept of reciprocal interaction can organize and illuminate interacting mechanisms across 3 levels of human organization, namely, broader contextual influences on patients and clinicians, specific patient-provider engagements, and specific patients. By using this rubric, we identified 10 distinct mechanisms proposed in the literature. Broader contextual influences include health care system structures; access to care; and poverty, socioeconomic status, social class, and family structure. Patient-clinician engagements encompass clinician bias, prejudice, and stereotypes; concordance of race; quality of information exchange; and trust. Patient-specific features include perceptions of control; religion and spirituality; and medical conditions. CONCLUSIONS: Differences and disparities in pediatric palliative and end-of-life care can be understood as arising from various mechanisms that interact across different levels of human organization, and this interactive multilevel model should be considered in designing studies or planning interventions to understand differences and to ameliorate disparities.
机译：目的：目的是阐明潜在的机制，以根除儿科姑息和临终关怀的差异/差异。方法：我们系统地搜索了在线数据库，以识别与儿科姑息治疗和临终关怀的差异/差异有关的文章，保留了19项研究进行评估。然后，我们对有关成人姑息治疗和临终关怀，普通儿科，成人医学和疼痛的差异/差异机制的文献进行了更广泛的评论，从而扩大了这一搜索范围。结果：互惠互动的概念可以组织和阐明人类组织三个层次上的互动机制，即对患者和临床医生的更广泛的环境影响，特定的患者-提供者参与和特定的患者。通过使用此标题，我们确定了文献中提出的10种不同的机制。广泛的环境影响包括卫生保健系统的结构;获得护理;贫困，社会经济地位，社会阶级和家庭结构。患者与临床医生的互动包括临床医生的偏见，偏见和成见;种族和谐;信息交流的质量;和信任。特定于患者的功能包括对控制的感知;宗教和灵性;和医疗条件。结论：儿科姑息治疗和临终护理的差异和差异可以理解为源于人类组织不同层面相互作用的各种机制，在设计研究或规划干预措施以了解差异和差异时应考虑采用这种互动的多层次模型。改善差距。

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