Improving patient outcomes in end-of-life care provided by physicians and nurses

改善医生和护士提供的临终关怀的患者结局

• 批准号: 8038446
• 负责人: J Randall Curtis
• 金额: $ 71.22万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-06-11 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8038446
• 关键词: Affect; Attitude; Cancer Patient; Caring; Cessation of life; Chronic; Communication; Control Groups; Effectiveness; Effectiveness of Interventions; Elderly; Evaluation; Faculty; Family; Family Nursing; Family member; Funding; Goals; Happiness; Health Knowledge, Attitudes, Practice; Heart Diseases; Interdisciplinary Communication; Internal Medicine; Intervention; Knowledge; Life; Liver diseases; Lung diseases; Malignant Neoplasms; Measures; Medical center; National Cancer Institute; Nurse Practitioners; Nurses; Outcome; Outcome Measure; Pain; Patient Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Performance; Physicians; Population Scientist Supplement (R25); Process; Process Measure; Questionnaires; Randomized; Randomized Controlled Trials; Research; Research Design; Research Personnel; Residencies; Sample Size; Self Assessment; Students; Surveys; Symptoms; Testing; Training; Training Programs; United States; design; end of life; experience; improved; innovation; intervention effect; oncology; patient oriented; primary outcome; programs; randomized trial; secondary outcome; skills; success

DESCRIPTION (provided by applicant): Three decades of research on end-of-life care in the U.S. indicate that patients frequently die with a significant burden of pain and other symptoms and often receive care that they would not choose. Patient- clinician communication about end-of-life care is an important focus for improving quality of patient-centered end-of-life care. Studies suggest that clinicians can improve their communication skills with experiential training, but no studies have shown that an intervention to improve clinician communication skill about end- of-life care improves patient outcomes. Furthermore, despite the knowledge that end-of-life care is best delivered in an interdisciplinary context, most studies do not incorporate interdisciplinary training. We propose to build on a state-of-the-art intervention, developed and implemented for oncology fellows through an R25 award funded by the National Cancer Institute, which is designed to improve clinician skills at communicating about end-of-life care. We will adapt the intervention for use in internal medicine and nurse practitioner training programs, one in the Northwest and one in the Southeast, and incorporate an innovative interdisciplinary training component. We will evaluate the intervention with patient-level outcomes using a questionnaire for assessing the quality of end-of-life care developed and validated in a prior RO1. The evaluation will target patients with cancer, patients with chronic heart, lung, or liver disease, and older adults. For internal medicine residents (n=291), the study design will be a randomized trial. For nurse practitioner (NP) students (n=96), we will use a before-after study design to accommodate sample size limitations. The primary aim is to evaluate the effectiveness of the communication intervention to improve the end-of- life care delivered by residents and NP students. The primary outcome measures are patient and family ratings of end-of-life care. As secondary outcomes, we will examine patient symptoms and end-of-life care as assessed by nurses. Secondary aims are: 1) to assess the intervention's success using process measures, including a validated knowledge test and attitudes survey, standardized patients, and learner self- assessment; and 2) to examine learner factors that facilitate or impede the effectiveness of the communication intervention to improve the quality of end-of-life care as assessed with both process (knowledge, attitudes, and behaviors) and outcome measures (patient and family ratings). This study will provide important information regarding the implementation and effectiveness of an interdisciplinary communication skills intervention for physicians and nurses with the goal of improving end- of-life care for patients and their families and reducing symptoms. The study will test the effectiveness of the intervention with patient- and family-level outcomes. If the intervention is effective, it offers the opportunity to improve the end-of-life care received by patients and their families throughout the US.

描述（由申请人提供）：美国关于临终关心的三十年研究表明，患者经常死亡，疼痛和其他症状很大，并且经常得到他们不会选择的护理。患者 - 临床医生关于临终护理的沟通是提高以患者为中心的寿命护理质量的重要重点。研究表明，临床医生可以通过经验培训提高他们的沟通能力，但是没有研究表明，提高临床医生沟通技巧的干预措施可以改善患者的结果。此外，尽管知道在跨学科的情况下最好地提供了临终关怀，但大多数研究并未纳入跨学科培训。我们建议通过由国家癌症研究所（National Cancer Institute）资助的R25奖项为肿瘤学研究员开发和实施的最先进的干预措施，该奖项旨在提高临床医生在沟通有关临终护理的技能。我们将调整用于内科和护士从业人员培训计划的干预措施，西北部一项，其中一项在东南部，并纳入创新的跨学科培训组成部分。我们将使用调查表评估患者级别的结果来评估评估先前RO1中开发和验证的寿命终止护理质量的干预措施。评估将针对患有癌症患者，患有慢性心脏，肺或肝病的患者以及老年人。对于内科医学居民（n = 291），研究设计将是一项随机试验。对于护士从业人员（NP）学生（n = 96），我们将使用前研究设计来适应样本量的限制。主要目的是评估沟通干预措施的有效性，以改善居民和NP学生提供的终止护理。主要结果指标是患者和家庭评级的临终护理。作为次要结果，我们将检查护士评估的患者症状和临终护理。次要目的是：1）使用过程指标评估干预措施的成功，包括经过验证的知识测试和态度调查，标准化患者和学习者的自我评估； 2）检查学习因素，以促进或阻碍交流干预的有效性，以提高通过过程（知识，态度和行为）和结果指标（患者和家庭评级）评估的寿命终止护理质量。这项研究将提供有关跨学科沟通技巧干预的实施和有效性的重要信息，以改善患者及其家人的终身护理和减轻症状的目的。该研究将测试患者和家庭水平结局的干预措施的有效性。如果干预措施有效，它将提供机会改善美国各地患者及其家人的终身护理。

项目成果

Physicians' and Nurse Practitioners' Level of Pessimism About End-of-Life Care During Training: Does It Change Over Time?

医生和护士在培训期间对临终关怀的悲观程度：它会随着时间的推移而改变吗？

• DOI: 10.1016/j.jpainsymman.2015.11.024
• 发表时间: 2016
• 期刊: Journal of pain and symptom management
• 影响因子: 4.7
• 作者: Long,AnnC;Downey,Lois;Engelberg,RuthA;Ford,DeeW;Back,AnthonyL;Curtis,JRandall
• 通讯作者: Curtis,JRandall

Life-sustaining treatment preferences: matches and mismatches between patients' preferences and clinicians' perceptions.

• DOI: 10.1016/j.jpainsymman.2012.07.002
• 发表时间: 2013-07
• 期刊: JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
• 影响因子: 4.7
• 作者: Downey, Lois;Au, David H.;Curtis, J. Randall;Engelberg, Ruth A.
• 通讯作者: Engelberg, Ruth A.

Training for effective patient communication--reply.

有效患者沟通培训--答复。

• DOI: 10.1001/jama.2014.1475
• 发表时间: 2014
• 期刊: JAMA
• 作者: Curtis,JRandall;Back,AnthonyL;Engelberg,RuthA
• 通讯作者: Engelberg,RuthA