预前照护计划干预效果的Meta分析

目的：系统综述和评价预前照护计划干预的应用效果。方法：计算机检索Cochrane图书馆、Pubmed、EMbase、中国生物医学文献数据库（CBM）、中国知网(CNKI)和万方数据库中关于预前照护计划的随机对照试验，按纳入及排除标准筛选文献并进行质量评价，采用RevMan 5.3软件处理，对纳入文献进行Meta分析。结果：共纳入14篇随机对照试验，受试者4 610例。Meta分析结果显示，干预组签署预先指示者多于对照组[OR=3.50，95%CI（1.89，6.51），P<0.01]；干预组代理人预测患者治疗意愿的准确性高于对照组[OR=3.58，95%CI（1.72，7.45），P=0.0007]；在决策冲突方面，干预组与对照组差异无统计学意义[WMD= -0.02，95%CI（-0.15，0.11），P=0.75]；同时干预有助于提高患者对预先指示的接受度，不会给患者带来任何心理精神方面的压力，但干预是否可以改善患者预先指示认知状况的证据尚不充分。结论：预前照护计划干预可以提高患者生命意愿表达率和代理人预测的准确性、有助于患者接受预先指示，不引发任何心理精神压力问题，但对患者决策冲突和认知水平的影响效果还不确定，仍有待临床开展多中心、大样本随机对照试验来证实。

The efficacy of advance care planning: A systematic review and meta-analysis

Objective: To systematically review the efficacy of advance care planning(ACP）interventions. Methods: The randomized controlled trials(RCT) on advance care planning were searched to collect from Cochrane Library, PubMed, EMbase, CBM, China National Knowledge Infrastructure(CNKI), and WANFANG database. After evaluated the quality of enrolled studies according to the inclusion and exclusion criteria, the meta-analysis was conducted with RevMan 5.3 software. Results: A total of 14 RCTs involving 4610 participants. The Meta-analysis showed that an increased likelihood for the completion of advance directives compared to usual care [OR=3.50，95%CI（1.89，6.51），P<0.01]; compared with the control group, the intervention group significantly improved patient-surrogate congruence[OR=3.58，95%CI（1.72，7.45），P=0.0007]; no significant difference in the decisional conflict between the intervention group and the control group [WMD= -0.02，95%CI（-0.15，0.11）, P=0.75]; an increased likelihood for the occurrence of acceptability on advance directives without psychosocial distress, but no evidence that ACP could improve cognitive status. Conclusion: ACP is effective to improve the completion of advance directives, the patient-surrogate congruence and the acceptability about advance directives, while the result of meta-analysis failed to support the effectiveness of ACP on decisional conflict and cognitive level. Large-scale and multi-centered randomized controlled trials are needed to confirm its effectiveness．