Improving The Quality Of Advanced Cancer Care With Disease Management

通过疾病管理提高晚期癌症护理的质量

• 批准号: 7849668
• 负责人: Barbara Daly
• 金额: $ 45.93万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-05 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7849668
• 关键词: Abnormal coordination; Accident and Emergency department; Acute; Address; Advanced Malignant Neoplasm; Attention; Cancer Center; Cancer Patient; Caregivers; Caring; Cause of Death; Chronic Disease; Clinical; Collaborations; Colorectal; Communication; Communities; Comprehensive Cancer Center; Diagnostic Neoplasm Staging; Disease; Disease Management; Disease remission; Effectiveness; Enrollment; Family; Fostering; Goals; Guidelines; Health Services Accessibility; Hospice Programs; Hospitalization; Human Resources; Individual; Intervention; Intervention Studies; Investigation; Life; Lung; Malignant Neoplasms; Malignant neoplasm of ovary; Measures; Modeling; Moods; National Comprehensive Cancer Network; Operative Surgical Procedures; Outcome; Ovarian; Pain management; Palliative Care; Pancreas; Patient Care; Patients; Persons; Phase; Philosophy; Prevention; Problem Solving; Process; Protocols documentation; Provider; Quality of Care; Quality of life; Relative (related person); Research; Resources; Services; Specialist; Staging; Symptoms; System; Testing; Therapeutic; Time; Visit; active method; aggressive therapy; cancer care; cancer therapy; care burden; care delivery; caregiving; chemotherapy; design; end of life; end of life care; end-of-life decision making; evidence base; experience; health related quality of life; hospice environment; improved; interdisciplinary collaboration; palliation; patient home care; preference; programs; psychologic; psychosocial; satisfaction; skills; symptom management; treatment as usual; treatment planning; Abnormal coordination; Accident and Emergency department; Acute; Address; Advanced Malignant Neoplasm; Attention; Cancer Center; Cancer Patient; Caregivers; Caring; Cause of Death; Chronic Disease; Clinical; Collaborations; Colorectal; Communication; Communities; Comprehensive Cancer Center; Diagnostic Neoplasm Staging; Disease; Disease Management; Disease remission; Effectiveness; Enrollment; Family; Fostering; Goals; Guidelines; Health Services Accessibility; Hospice Programs; Hospitalization; Human Resources; Individual; Intervention; Intervention Studies; Investigation; Life; Lung; Malignant Neoplasms; Malignant neoplasm of ovary; Measures; Modeling; Moods; National Comprehensive Cancer Network; Operative Surgical Procedures; Outcome; Ovarian; Pain management; Palliative Care; Pancreas; Patient Care; Patients; Persons; Phase; Philosophy; Prevention; Problem Solving; Process; Protocols documentation; Provider; Quality of Care; Quality of life; Relative (related person); Research; Resources; Services; Specialist; Staging; Symptoms; System; Testing; Therapeutic; Time; Visit; active method; aggressive therapy; cancer care; cancer therapy; care burden; care delivery; caregiving; chemotherapy; design; end of life; end of life care; end-of-life decision making; evidence base; experience; health related quality of life; hospice environment; improved; interdisciplinary collaboration; palliation; patient home care; preference; programs; psychologic; psychosocial; satisfaction; skills; symptom management; treatment as usual; treatment planning

DESCRIPTION (provided by applicant): Patients with advanced stage cancer have need for access to both cure-oriented therapies and palliation. The National Comprehensive Cancer Network (NCCN) identifies the goal of palliative care as the prevention and relief of suffering regardless of the stage of disease and regardless of whether palliative care is provided concurrently with life-prolonging care or as the main focus of care. Despite recognition of the importance of symptom management expertise and attention to the psychosocial aspects of the cancer experience, patients continue to identify shortcomings in palliative care and end-of-life care, including lack of coordination and communication, difficulty accessing care, inadequate symptom management, and prolongation of the dying process. Significant improvements require changes in the care delivery system in order to assure that: (a) patients have access to expert management of physical, psychological, and spiritual needs as well as excellent curative therapy (b) families of patients receive the same expert support; (c) access to professionals who have the skills and time to assist patients and their families make the transition from a primary goal of cure to a primary goal of palliation is readily available; and (d) a coordinated transition to community providers, such as home care, palliative care programs, and hospice occurs. There is growing evidence that disease management is a care delivery model that is able to specifically address these needs, although it has never been tested in an academic cancer center. The purpose of this investigation is to implement a comprehensive disease management program (DMP) and measure effects on quality of life and quality of care of advanced cancer patients and their families, and to examine the effects on resource use. A two-group, quasi-experimental, tandem enrollment design will be used. Research questions are: (1) Is there a difference in resource use (number of chemotherapy treatments in the last 30 days of life, number of emergency room visits, number of days of hospice and hospitalization) among patients with advanced cancer who have participated in a DMP compared to those receiving usual care? (2) Is there a difference in patient outcomes (health related quality of life, spiritual well being, satisfaction with care) among patients with advanced cancer who have participated in a DMP compared to those receiving usual care? (3) Is there a difference in caregiver outcomes (mood state, satisfaction with care, satisfaction with end of life care, and burden of caregiving) among caregivers of patients with advanced cancer who have participated in a DMP compared to those receiving usual care? (4) Do the differences in patient and caregiver outcomes remain after controlling for the influence of demographic, clinical and organizational covariates? (5) To what extent are differences in patient and caregiver outcomes achieved through improvements in collaboration and problem solving?

描述（由申请人提供）：患有晚期癌症的患者需要接受面向治疗的疗法和抑制。国家综合癌症网络（NCCN）将姑息治疗的目标确定为预防和缓解痛苦，无论疾病的阶段如何，无论是与生命的护理同时提供姑息治疗，还是作为护理的主要重点。尽管认识到症状管理专业知识的重要性以及对癌症经验的心理社会方面的重要性，但患者仍在继续确定姑息治疗和临终关心的缺点，包括缺乏协调和沟通，难以获得症状管理，不足的症状管理以及垂死过程的延长。重大改进需要改变护理服务系统，以确保：（a）患者有身体，心理和精神需求的专家管理以及出色的治疗疗法（b）患者家族获得相同的专家支持； （c）可以访问具有帮助患者及其家人的技能和时间的专业人员，可以轻松获得从治愈的主要目标过渡到主要目标的过渡； （d）向社区提供者的协调过渡，例如家庭护理，姑息治疗计划和临终关怀。越来越多的证据表明，疾病管理是一种能够专门满足这些需求的护理交付模型，尽管从未在学术癌症中心进行过测试。这项调查的目的是实施一项全面的疾病管理计划（DMP），并衡量对高级癌症患者及其家庭护理质量和护理质量的影响，并检查对资源使用的影响。将使用两组的准实验，串联入学设计。研究问题是：（1）与接受常规护理的患者相比，患有参与DMP的晚期癌症患者的资源使用量（在急诊室的最后30天，急诊室就诊数量，临终关怀和住院时间的数量，临终关怀和住院时间的数量）是否存在差异？ （2）与接受常规护理的患者相比，参加DMP的患者的患者结局（与健康相关的生活质量，精神健康，对护理的满意度）有差异吗？ （3）与接受常规护理的患者相比，参与DMP的患者的护理人员的护理人员结果（情绪状态，对护理的满意度，对终止护理的满意度，对终止护理的满意度，对终止护理的满意度以及护理负担）有差异吗？ （4）在控制人口，临床和组织协变量的影响后，患者和照料者结果的差异是否仍然存在？ （5）通过改善协作和解决问题的患者和照顾者成果的差异在多大程度上？