慢性閉塞性肺疾患療養者を対象としたアドバンスケアプランニングの有効性：システマティックレビューとメタアナリシス

Effectiveness of Advance Care Planning for People with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

要旨

　目的：慢性閉塞性肺疾患（COPD）へのアドバンスケアプランニング（ACP）の有効性をシステマティックレビューとメタアナリシスにより明らかにする．

　方法：検索データベースは，CENTRAL，PubMed，CINAHL Plus with Full Text，Embase，PsycInfoとし，ランダム化比較試験を収集した．分析は，質的・量的統合およびエビデンス総体の質を評価した．

　結果：4研究を採択した．両群間で事前指示書作成割合（risk ratio (RR) = 1.29; 95% confidence-interval　(CI) [1.04〜1.59]; p = .02），終末期ケアの話し合いの実施割合（RR = 1.55; 95% CI [1.02〜2.37]; p = .04）に有意差が示された．

　結論：COPDへのACPは文書化や終末期の対話を促進する可能性が示唆されたが，バイアスリスクや小規模試験に基づきエビデンスの確証は限定的である．

　Aims: To identify the effectiveness of advance care planning (ACP) for chronic obstructive pulmonary disease (COPD) by undertaking a systematic review and meta-analysis of relevant research findings.

　Methods: The databases searched were CENTRAL, PubMed, CINAHL Plus with Full Text, Embase, and PsycInfo, from which randomized controlled trials were collected. Analysis was performed by qualitative and quantitative integration and GRADE evaluation.

　Results: 4RCTs (918 participants) were included in this review. The intervention group showed significant differences in advance directive completion (risk ratio (RR) 1.29; 95% confidenceinterval (CI) [1.04-1.59]; p = .02) and end-of-life discussion (RR 1.55; 95%CI [1.02-2.37]; p = .04).

　Conclusions: The results suggest that ACP for COPD may improve documentation and end-of-life discussions, however, the certainty of the evidence is limited based on the risk of bias and small studies.