運用AMBER照護模式於病況不確定性病人提升照護品質之成效

The Effect of AMBER (Assessment, Management, Best Practice, Engagement, Recovery) Care Bundle to Improve Healthcare Quality of Patients Whose Recovery is Uncertain

臨床上，對於病況不確定性高之病人，較少探討何時應開始討論生命晚期照護需求，並啟動安寧緩和療護。源自於英國的AMBER照護模式（The Assessment, Management, Best Practice, Engagement, Recovery Uncertain care bundle）適用於病情不穩定、並且可能正在接近生命的盡頭的患者，它包含5大關鍵要素：評估、管理、實踐、參與、康復狀況具不確定性的病人。此模式通過一系列的照護評估過程來識別問題，以改善延遲識別生命末期需求之情況。本研究旨在運用系統性文獻回顧，探討以AMBER照護模式提升病況不確定性病人照護品質的成效。本文遵循PRISMA（Preferred Reporting Items for Systematic reviews and Meta-Analyses）準則進行文獻搜尋，並使用CASP（Critical Appraisal Skills Program）工具進行文獻評讀。結果共納入3篇文章，證據等級為中等，GRADE（The Grading of Recommendations Assessment, Development and Evaluation approach）建議強度為強。在其中2篇隨機對照試驗中，研究者使用howRwe測量患者的經驗，結果顯示兩組間無顯著差異，另以整合緩和照護結果量表（Integrated Palliative care Outcome Scale, IPOS）測量病人的安寧緩和療護症狀和擔憂，結果發現介入組的症狀困擾程度較高，但使用AMBER照護模式後有下降趨勢，且成本效益分析顯示顯示在合理範圍內，參與者對此亦有正向看法。另1篇世代研究則利用訪談及回溯方式，調查病人的照護經驗，結果顯示皆有顯著效益。總結來說，本文提供了AMBER照護模式的實證基礎和臨床路徑，可作為實務應用之參考依據。

Few studies have investigated the patient’s end-of-life care needs or the appropriate timing of initiating palliative care for patients with deteriorating and uncertain conditions in clinical practice. The Assessment, Management, Best Practice, Engagement, Recovery Uncertain (AMBER) care bundle was designed to improve the issues of delayed identification of end-of-life needs. The literature has not systematically explored the effectiveness of the AMBER care bundle, and there is no consistent method to implement. The aim of this study was to explore the effect of the utilization of the AMBER care bundle to improve the health care quality of patients whose recovery is uncertain. A systematic review was used. We followed the PRISMA criteria to search for, screen, qualify and include studies. Data extraction was carried out after screening. The selected studies were further evaluated for quality deviation by using the Critical Appraisal Skills Program (CASP). Three eligible studies relevant to the research topic were selected for analysis. The 3 studies had medium-level evidence, and the grade of recommendation was rated high by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Two randomized controlled trial (RCT) studies that used howRwe to evaluate the patient experience and Integrated Palliative care Outcome Scale (IPOS) to evaluate palliative care symptoms and concerns showed no significant difference. The intervention group had higher levels of symptom distress, but there was a downward trend. The results of a cost-benefit analysis of the AMBER care bundle was within an affordable range, and there was positive feedback from patients. A cohort study was conducted by interviews and follow-up surveys to investigate the experiences of patients who received the AMBER care bundle. The results of this study showed that all patients had significant benefits. This systematic review provides an evidence basis for the implementation of the AMBER care bundle to improve the quality of care for clinically uncertain patients and proposes a clinical pathway as a reference for practical application.