BACKGROUND Despite recommendations to integrate palliative care into nursing home care, little is known about the most effective ways to meet this goal. OBJECTIVE To examine the characteristics and effectiveness of nursing home interventions that incorporated multiple palliative care domains (eg, physical aspects of care-symptom management, and ethical aspects-advance care planning). DESIGN Systematic review. METHODS We searched MEDLINE via PubMed, Embase, CINAHL, and Cochrane Library's CENTRAL from inception through January 2019. We included all randomized and nonrandomized trials that compared palliative care to usual care and an active comparator. We assessed the type of intervention, outcomes, and the risk of bias. RESULTS We screened 1167 records for eligibility and included 13 articles. Most interventions focused on staff education and training strategies and on implementing a palliative care team. Many interventions integrated advance care planning initiatives into the intervention. We found that palliative care interventions in nursing homes may enhance palliative care practices, including processes to assess and manage pain and symptoms. However, inconsistent outcomes and high or unclear risk of bias among most studies requires results to be interpreted with caution. CONCLUSIONS AND IMPLICATIONS Heterogeneity in methodology, findings, and study bias within the existing literature revealed limited evidence for nursing home palliative care interventions. Findings from a small group of diverse clinical trials suggest that interventions enhanced nursing home palliative care and improved symptom assessment and management processes.

中文翻译：

---

疗养院姑息治疗干预的系统评价：特征和结果

背景 尽管建议将姑息治疗整合到疗养院护理中，但对于实现这一目标的最有效方法知之甚少。目的 研究包含多个姑息治疗领域（例如，护理的身体方面-症状管理和伦理方面-预先护理计划）的疗养院干预措施的特点和有效性。设计系统审查。方法 我们通过 PubMed、Embase、CINAHL 和 Cochrane Library 的 CENTRAL 检索了 MEDLINE 从开始到 2019 年 1 月的时间。我们纳入了所有将姑息治疗与常规治疗和积极对照进行比较的随机和非随机试验。我们评估了干预的类型、结果和偏倚风险。结果 我们筛选了 1167 条记录的资格，包括 13 篇文章。大多数干预措施侧重于员工教育和培训策略以及实施姑息治疗团队。许多干预措施将预先护理计划举措纳入干预措施。我们发现疗养院的姑息治疗干预措施可能会加强姑息治疗实践，包括评估和管理疼痛和症状的过程。然而，大多数研究的结果不一致以及偏倚风险高或不明确，需要谨慎解释结果。结论和意义 现有文献中方法、结果和研究偏倚的异质性揭示了疗养院姑息治疗干预的有限证据。来自一小组不同临床试验的结果表明，干预措施增强了疗养院的姑息治疗并改善了症状评估和管理过程。