Systematic Assessment to Improve Hospice Outcomes

改善临终关怀结果的系统评估

• 批准号: 6943414
• 负责人: SUSAN C MCMILLAN
• 金额: $ 46.58万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6943414
• 关键词: adult human (21+); bereavement; caregivers; clinical research; depression; diagnosis design /evaluation; diagnostic tests; health care service evaluation; health services research tag; home health care; hospices; human subject; interdisciplinary collaboration; longitudinal human study; neoplasm /cancer; nursing research; outcomes research; patient care management; patient oriented research; psychological adaptation; psychometrics; quality of life; religion; sign /symptom; social service; terminal patient care

DESCRIPTION (provided by applicant): Complete, accurate, and systematic assessment is known to be essential for providing effective care in any setting. However, research reveals that this assessment is frequently missing from patient records, leading to care that are less than ideal. This need for careful assessment is no less necessary in hospice homecare. Growing numbers of patients are receiving hospice care each year; thus, improving assessment in this setting has the potential for improving care to thousands of patients each day. The primary aims of this study are to determine the efficacy of providing systematic feedback from standardized assessment tools for hospice patients and caregivers in improving hospice outcomes compared to usual practice, and in addition, using those standardized assessments, to identify symptom clusters in hospice patients and how they impact on patient and caregiver well-being. Patient outcomes to be measured include symptom intensity and distress, quality of life, depression, and spiritual well-being. Caregiver outcomes being measured include depression, spiritual well-being during active care, and depression 3 and 12 months after the death. The sample of 306 patient/caregiver dyads will be drawn from three large hospices that are partners in the Center for Hospice, Palliative Care and End of Life Studies at the University of South Florida. Patients must have cancer, and will be screened using the Short Portable Mental Status Questionnaire and the Palliative Performance Scale. In each hospice, two interdisciplinary care teams will be identified that provide homecare to equivalent groups of patients; one will be randomized as the control team and one the experimental team. Patients and caregivers on all teams will be admitted to the study 24-72 hours after admission to hospice and will complete all assessments. For the experimental teams, the RN's and social workers who are collecting the data will attend the weekly interdisciplinary team meetings and report the data they have collected during the previous week. Data collection and reporting will occur at baseline and then weekly for two weeks at which time the patients will be finished with the study. In order to monitor care changes that result from the enhanced assessments, charts will be audited to compare the numbers of home visits and medication and other careplan changes between the experimental and control groups. Caregivers will be visited again at 3 and 12 months after the death to evaluate whether the improved care provided to patients on the experimental teams resulted in significantly less depressive symptoms. Patient/caregiver dyads will be accrued for 30 months with an additional 12 months of follow-up data collection for depression data. Quantitative data will be analyzed using mixed models analysis, repeated measures multivariate analysis of variance, discriminant function analysis and cluster analysis.

描述（由申请人提供）：已知完整，准确和系统评估对于在任何情况下提供有效的护理至关重要。但是，研究表明，这种评估经常因患者记录而缺失，从而导致不理想的护理。在临终关怀中，对仔细评估的需求同样不少。每年越来越多的患者接受临终关怀护理；因此，在这种情况下改善评估有可能改善每天数千名患者的护理。这项研究的主要目的是确定与常规实践相比，从标准化评估工具和护理人员改善临终关怀结果的标准化评估工具提供系统反馈的功效，此外，还使用这些标准化评估，以识别临终关怀患者的症状簇以及对患者和护理人员的福祉的影响。待测量的患者结局包括症状强度和困扰，生活质量，抑郁和精神福祉。测量的护理人员的结果包括抑郁症，活跃护理期间的精神福祉以及死亡后3和12个月的抑郁症。 306名患者/护理人员二元组的样本将来自三个大型临终关怀医院，这些临终关怀医院是临终关怀中心，姑息治疗和南佛罗里达大学生命终结研究的合作伙伴。患者必须患癌症，并将使用短便携式心理状态问卷和姑息性绩效量表进行筛查。在每个临终关怀中，将确定两个跨学科护理团队为同等的患者提供家庭护理；一个将被随机分为控制团队，一个实验团队。入院临终关怀后24-72小时，所有团队中的患者和护理人员将被录取，并将完成所有评估。对于实验团队，收集数据的RN和社会工作者将参加每周的跨学科团队会议，并报告他们上周收集的数据。数据收集和报告将在基线发生，然后每周进行两周，此时患者将完成研究。为了监视增强评估导致的护理变化，将审核图表，以比较实验组和对照组之间的家庭访问和药物的数量以及其他Careplan变化。死亡后3和12个月将再次访问护理人员，以评估是否为实验团队中的患者提供的改进护理导致抑郁症状明显减少。患者/护理人员的二元组将在30个月内进行30个月的收集，并为抑郁症数据收集了12个月的随访数据。将使用混合模型分析，重复测量方差分析，判别功能分析和群集分析来分析定量数据。