Hospice Intervention for Older Adults With ESRD

患有 ESRD 的老年人的临终关怀干预

• 批准号: 7101627
• 负责人: LEWIS MITCHELL COHEN
• 金额: $ 24.79万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-01 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7101627
• 关键词: albumins; behavioral /social science research tag; caregivers; chronic renal failure; clinical research; comorbidity; family; focus groups; health care quality; health care referral /consultation; health care service availability; health care service evaluation; health services research tag; hemodialysis; hospices; human old age (65+); human subject; outcomes research; patient care personnel relations; prognosis; quality of life; terminal patient care

DESCRIPTION (provided by applicant): No more than 13% of patients with end-stage renal disease (ESRD) receive hospice services, which contrasts with the 23% of all Medicare decedents and 60% of those dying of cancer. This exploratory study intends to develop an intervention to increase access to hospice care; its goals are to improve the terminus of life for the large number of elderly people with ESRD and provide greater support for their loved-ones. In Phase I, nine focus groups and a qualitative analysis will be used to refine the intervention. In Phase II, a feasibility trial will examine the impact of the intervention with a quantitative analysis. Dialysis facilities providing hemodialysis to 529 prevalent and incident patients will be divided into a block of two intervention clinics and a block of two control clinics. Patients will be screened to identify those who have life-limiting illness by using nephrologist prognostic estimates, serum albumin levels, and the Charlson Comorbidity Index. A Renal Supportive Care Team consisting of staff members from community hospices and dialysis facilities will meet with patients and families to acquaint them with the option of hospice and to encourage reflection on goals for end-of-life care. The team will also provide educational outreach to the staff of facilities, e.g. hospitals, nursing homes, etc., where these patients commonly die, and explore ways to simplify and facilitate hospice referral. The intervention will be provided to the dialysis staff and to subjects (n=67) from the intervention block, while subjects (N=62) from the control block will receive usual care. During a 20 month data collection period, the circumstances surrounding all deaths will be examined, and the key outome variables will be the provision of hospice care and family support. The family perspective will be elicited through use of two standardized palliative care intruments, the FAMCARE and the FEHCI. Three-quarters of the more than 75,000 patients with ESRD who die this year will be over 65 years old; most of the deaths will be accompanied by pain and other distressing symptoms, and they will occur in institutional settings. Hospices are available throughout the United States, and they represent a valuable and underutilized resource for the provision of quality care of older patients with kidney disease. The study is intended to form the basis of a future, and more ambitious multicenter research investigation (an R01) to examine whether increased use of hospice services improve ESRD quality-of-life and end-of-life care.

描述（由申请人提供）：终末期肾脏疾病（ESRD）的患者中，不超过13％的临终关怀服务，这与所有医疗保险死者中的23％和死于癌症死亡的患者中有60％形成鲜明对比。这项探索性研究旨在制定干预措施以增加获得临终关怀的机会；它的目标是改善ESRD的大量老年人的生活终点，并为自己的亲人提供更大的支持。在第一阶段，将使用九个焦点小组和定性分析来完善干预措施。在第二阶段，可行性试验将通过定量分析检查干预的影响。向529名流行的血液透析的透析设施将分为两个干预诊所的一个街区和两个控制诊所的街区。通过使用肾脏科医生的预后估计，血清白蛋白水平和Charlson合并症指数，将对患者进行筛查，以识别患有生命疾病的人。由社区临终关怀和透析设施的员工组成的肾脏支持团队将与患者和家人见面，以使他们熟悉临终关怀的选择，并鼓励对临终关怀的目标进行反思。该团队还将向设施工作人员提供教育宣传，例如这些患者通常死亡的医院，疗养院等，并探索简化和促进临终关怀转诊的方法。干预措施将提供给透析工作人员和干预区的受试者（n = 67），而控制区的受试者（n = 62）将获得常规护理。在一个20个月的数据收集期内，将检查所有死亡的情况，关键的Outome变量将是提供临终关怀和家庭支持。家庭观点将通过使用两个标准化的姑息治疗仪器（Famcare and the Fehci）来引起。在今年死亡的75,000多名ESRD患者中，有四分之三超过65岁；大多数死亡将伴随着疼痛和其他令人痛苦的症状，并且会发生在机构环境中。全美都可以使用临终关怀，它们代表了一种有价值的肾脏疾病患者质量护理的宝贵且未被充分利用的资源。该研究旨在构成未来，更雄心勃勃的多中心研究调查（R01）的基础，以检查增加使用临终关怀服务是否可以改善ESRD寿命质量和寿命终止护理。