Effects & Costs of Massage in Hospice Cancer Patients

效果

• 批准号: 7032533
• 负责人: DIANA J WILKIE
• 金额: $ 51.26万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-30 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7032533
• 关键词: caregivers; clinical research; clinical trials; computer human interaction; computer program /software; coping; emotions; health care cost /financing; hospices; human subject; human therapy evaluation; massage therapy; neoplasm /cancer palliative treatment; pain; patient oriented research; sign /symptom; sleep; statistics /biometry; training

DESCRIPTION (provided by applicant): More than 80% of hospice patients experience distressing symptoms that significantly impact comfort in their final days of life. Previous research demonstrated that complimentary therapies such as massage can alleviate symptoms for minutes to hours, but none have examined cumulative effects of massage therapy or cost-effective methods of providing massage to hospice patients. We propose a randomized clinical trial (RCT) comparing usual care versus usual care plus 5 daily massage therapy sessions given by licensed massage therapists (LMT) on symptom outcomes including: a) symptom distress, b) pain, c) mood state and d) sleep quality in a diverse group of 200 hospice patients with cancer. In a pre-test/post-test design with repeated measures preceded by a 5-day run-in period, patients will complete computerized assessments. All patients will receive usual home care level of hospice care, and patients randomized to the experimental group will receive daily massage therapy for 1 week. Outcome scores will be aggregated for each variable from day 2 to day 6 and analyzed using MANOVA, with post-hoc comparisons if significant group results are obtained. Study findings will be used to guide hospice care providers in selecting evidence-based complimentary interventions to relieve distressing symptoms in people at the end of life. A second aim is to determine the costs of the massage intervention and compare the effects of usual hospice care and usual care plus massage on hospice reimbursement and utilization costs. We will use a 2-step activity-based costing methodology for determining the costs of the intervention and the effects on cost outcomes. We hypothesize that the hospice reimbursements and utilization costs will not differ, meaning that the intervention will be cost neutral. A third exploratory aim is to describe the feasibility and the caregiver strain of LMT training 60 family caregivers to give daily massages at home to 60 of the hospice patients who completed Aim 1 procedures. Feasibility will be evaluated by: a) caregiver massage proficiency; b) massage frequency and length given by caregivers; c) caregiver and patient self-report about the massage experience. Strain is defined as the 1-week change in caregiver strain. We expect that family caregivers will be trained to give massages at a proficient level after 2 sessions with training, evaluation and feedback from a LMT. We also expect that caregivers will give 3 daily massages, each for 20 to 30 minutes and report no significant increase in their caregiver strain. Descriptive statistics and content analysis with Atlas.ti will be used to evaluate the feasibility of family caregivers providing massages and to design a clinical effectiveness study using family members as a cost-effective alternative to LMTs.

描述（由申请人提供）：超过80％的临终关怀患者经历了令人痛苦的症状，从而极大地影响了他们生命的最后日子。先前的研究表明，按摩等免费疗法可以减轻症状，数分钟至几个小时，但没有人检查按摩疗法的累积影响或为临终关怀患者提供按摩的成本效益方法。我们提出了一项随机护理与通常的护理以及5日的按摩治疗师（LMT）对症状结局进行的每日按摩治疗课程的随机临床试验（RCT），包括：a）症状困扰，b）疼痛，c）情绪状态和D）一组由200名临终关怀患者组成的多样化组中的睡眠质量。在预测试/后测试设计之前，以5天的重复措施进行了重复测量，患者将完成计算机评估。所有患者将获得通常的家庭护理临终关怀护理水平，随机分配给实验组的患者将每天接受按摩疗法1周。从第2天到第6天，每个变量将汇总结果评分，并使用MANOVA进行分析，如果获得了重大的组结果，则将进行事后比较。研究结果将用于指导临终关怀医疗提供者选择基于证据的免费干预措施，以减轻生命尽头的痛苦症状。第二个目的是确定按摩干预的成本，并比较通常的临终关怀护理和通常的护理以及按摩对临终关怀的报销和利用成本的影响。我们将使用基于2步活动的基于活动的成本核算方法来确定干预成本以及对成本结果的影响。我们假设临终关怀的报销和利用成本不会有所不同，这意味着干预将是成本中立的。第三个探索性目的是描述LMT培训的可行性和护理人员应变60家家庭护理人员，以便每天在家按摩60名完成AIM 1程序的临终关怀患者。可行性将通过：a）护理人员按摩水平； b）护理人员给出的按摩频率和长度； c）关于按摩体验的护理人员和患者自我报告。应变定义为护理人员菌株的1周变化。我们预计，在2次会议之后，将对家庭护理人员进行培训，并通过LMT的培训，评估和反馈进行按摩水平。我们还期望护理人员每天进行3次按摩，每次按摩20至30分钟，并报告其护理人员的压力没有显着增加。使用Atlas.ti的描述性统计和内容分析将用于评估提供按摩的家庭护理人员的可行性，并使用家庭成员作为LMT的具有成本效益的替代品设计临床有效性研究。