Aim: To describe and explain the process of transition from cure-focused to comfort-focused health care as perceived and reported by patients, family members, and healthcare providers.
Background: Moving into the last phase of life due to advanced illness constitutes a developmental transition with increased vulnerability for patients and family.
Design: Qualitative metasynthesis.
Data sources: Medline, CINAHL, and PsycInfo databases searched from inception through March 2016. Primary research reports published from 1990 to 2015, using qualitative designs to report transition experiences of patients, family members, and/or healthcare providers were included.
Review methods: Key elements were extracted and organized into matrices. Findings from each report were analysed using qualitative coding.
Results: The sample was 56 unique reports from 50 primary studies. Patients and families emphasized the importance of receiving understandable information, emotional support, respect for personhood and control. The critical juncture of 'realizing terminality' preceded a transition to comfort-focused care. Subsequently, a shift in goals of care emphasizing comfort and quality of life could occur. Continued provision of information, effective support, respect and control promoted 'reframing perceptions' and capacity to embrace a changed identity. Reframing allowed patient and family to find meaning and value in this last phase of life and to embrace the opportunity to prepare for death, nurture relationships, and focus on quality of living.
Conclusion: Understanding the developmental process that can be engaged by patients and families at the end of life provides a theoretical basis that can inform choice and timing of interventions to reduce suffering and enhance positive outcomes.
目的: 描述和解释患者、家庭成员和医疗保健机构所认为和报告的从以治疗为中心向以舒适为中心的医疗保健转变的过程。 背景: 由于晚期疾病进入生命的最后阶段形成了一个发展过渡期,患者及其家庭不堪一击。 设计: 定性综合集成。 数据来源: 可通过Medline、CINAHL和PsycInfo数据库进行搜索(从最初到2016年3月),包括1990年至2015年发布的初步研究报告,采用定性设计报告患者、家庭成员和/或医疗保健机构的转变历程。 评估方法: 提取关键元素并组织成矩阵,使用定性编码分析每个报告的结果。 结果: 该样本来自50项初步研究的56份独特报告。病人和家属认为接受明确信息、情感得到支持、人格得到尊重、病情得到控制等方面十分重要。在“认识到末期症状”的关键时刻后,过渡到以舒适为中心的护理。随后,护理目标可能会发生转变,以强调舒适和生活质量为中心。持续提供信息、给予有效支持、尊重和管理,促进了“重塑观念”,提高接受现实的能力。重塑观念使患者和家庭能够在患者生命的最后阶段找到意义和价值,为迎接死亡做好准备,培养人际关系、关注生活质量。 结论: 了解患者及其家庭在患者临终时可能面临的发展过程,为减少其痛苦、提高积极影响的干预措施的选择和时机提供理论依据。.
Keywords: comfort care; end of life; literature review; metasynthesis; nursing; palliative care; qualitative research; terminal care; transition.
© 2019 John Wiley & Sons Ltd.