在选择临床实践建议的分级系统的务实方法在息护理中的临床实践建议
Sasha Voznyuk1, Rachel Z Carter2,3, Julia Ridley2,3
1Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Palliative medicine
|October 6, 2024
概括
息护理指南由于证据有限而与分级系统作斗争. 美国传染病学会-欧洲医疗瘤学会 (IDSA-ESMO) 系统为指南开发者和临床医生提供了一种实际的解决方案.
科学领域:
- 抚慰性护理医学 抚慰性护理医学
- 基于证据的实践.
- 临床指南开发 临床指南开发
背景情况:
- 息治疗的证据基础往往有限,这使得很难应用临床指南中使用的标准分级方案.
- 许多息治疗建议依赖于专家的共识或临床实践标准,经常被归类为低质量的证据.
- 这可能导致提供者在执行建议时犹,影响患者的护理.
研究的目的:
- 确定和合理化用于息护理临床实践指南中使用的证据评估的最合适的分级系统.
- 为应对应用现有分级系统在息护理独特证据环境中的挑战.
主要方法:
- 进行了以英语出版的国际息护理指南的方法部分的审查.
- 五个分级系统进行了比较:推,评估,发展和评估分级 (GRADE);苏格兰大学间指南网络 (SIGN);美国传染病学会-欧洲医学瘤学会 (IDSA-ESMO);对定性研究审查证据的信心 (CERQual);和长期条件的国家服务框架 (NSF-LTC).
主要成果:
- 在息治疗和末期症状管理指南的分级系统中存在显著的异质性.
- 由于其严谨性和一致性,GRADE系统越来越多地被采用,而CERQual显示出对定性证据的潜力,但其作用不那么明确.
- IDSA-ESMO系统提供了一个直观的框架来分类低质量的证据.
结论:
- 将标准分级系统应用于息治疗是具有挑战性的,因为经常缺乏强大的随机对照试验 (RCT).
- IDSA-ESMO分级系统为指南制定者和临床医生提供了可行和实用的替代方案,特别是那些资源有限或方法专业知识有限的人.
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