The Living Well Project: Early Palliative Care and MI for persons with AIDS

美好生活项目：艾滋病患者的早期姑息治疗和心肌梗死

• 批准号: 8551714
• 负责人: MARCIA McDonnell Holstad
• 金额: $ 43.26万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-27 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8551714
• 关键词: AIDS diagnosis; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adherence; Advance Care Planning; Advocacy; Alcohol or Other Drugs use; Anti-Retroviral Agents; Appointment; Appointments and Schedules; Caring; Cessation of life; Chronic; Clinical; Communicable Diseases; Consensus; Coping Skills; Decision Making; Diagnosis; Disease; Early treatment; Enrollment; Fatigue; Goals; HIV; Health; Health system; Hospitalization; Impaired cognition; Intervention; Life; Link; Measures; Mental Depression; Methods; Modeling; Moods; Movement; Names; Neurobehavioral Manifestations; Newly Diagnosed; Nurses; Opportunistic Infections; Outcome; Outpatients; Pain; Palliative Care; Patient Care; Patients; Persons; Pharmaceutical Preparations; Quality of life; Quality-Adjusted Life Years; Recruitment Activity; Regimen; Reporting; Services; Social support; Spirituality; Stroke; Supportive care; Symptoms; Testing; Time; Visit; antiretroviral therapy; behavior change; coping; cost; cost effective; cost effectiveness; efficacy testing; gastrointestinal; improved; innovation; inpatient service; life time cost; mortality; motivational enhancement therapy; multidisciplinary; programs; psychologic; psychosocial; routine care; satisfaction; social; social stigma; standard care; symptom management

DESCRIPTION (provided by applicant): Early palliative care is now recommended for persons at the time of diagnosis of a life threatening illness. We plan to test the efficacy of an enhanced model of early palliative care (EPC) services for persons newly diagnosed with AIDS and admitted to either the inpatient service or outpatient infectious disease program (IDP) at the Grady Health System in Atlanta, GA (GHS). Our AIDS EPC Package includes 3 palliative care visits and four weekly motivational interviewing (MI) sessions to provide supportive care, symptom management, and facilitate adjustment to diagnosis and advance care planning decision making. The project has three specific aims: 1. Conduct a RCT to examine the efficacy of the AIDS EPC Package intervention vs. standard HIV care (SOC) and compare outcomes at 12 months post baseline. Our hypothesis is that those in the AIDS EPC group will have: i) Better clinical outcomes: a lower one year mortality, higher proportion who initiate antiretroviral therap (ART), higher proportion with virologic suppression, higher CD4 gain, fewer opportunistic infections (OI), fewer hospitalizations, lower depression scores, and better symptom management (including cognitive dysfunction). ii) Better psychosocial outcomes: Better coping skills, higher perceived social support, higher spirituality, higher levels of self-advocacy, lower proportion who report substance use. iii) Better Quality of Life (QOL) and a higher proportion who report advance care planning activities: named a surrogate; set personal goals regarding life saving measures; and discussed these goals with a surrogate. 2. Evaluate the cost effectiveness and cost utility of the AIDS EPC Package compared to SOC where the outcomes are valued as survival and quality-adjusted life years (QALYs) respectively. 3. Promote engagement and retention in HIV care as evidenced by keeping a higher proportion of appointments and reporting higher satisfaction with care compared to SOC. We believe palliative care (PC) - with a focus on supportive, symptom-oriented care - is an ideal method to optimize the treatment of newly diagnosed persons with AIDS and promote engagement and retention in care. The comprehensive and multidisciplinary administered AIDS EPC Package includes spiritual, social, psychological, cognitive, and symptom management, with the addition of four weekly one-on-one motivational interviewing sessions conducted by nurses to facilitate disease adjustment and decision making about advance care planning. We posit that integrating EPC in the care of newly diagnosed AIDS patients will greatly improve QOL, clinical and psychosocial outcomes, and advance care planning at a lower cost than standard care. This caring approach will enhance engagement and retention in care and promote movement toward personal self-advocacy and quality of life.

描述（由申请人提供）：现在建议在诊断出危及生命的疾病时对人们进行早期姑息治疗。我们计划测试早期姑息治疗 (EPC) 服务增强模式的有效性，该模式针对新诊断出的艾滋病患者并在佐治亚州亚特兰大的格雷迪卫生系统 (GHS) 的住院服务或门诊传染病计划 (IDP) 中接受治疗。 ）。我们的艾滋病 EPC 套餐包括 3 次姑息治疗就诊和四次每周动机访谈 (MI) 课程，以提供支持性护理、症状管理并促进诊断调整和预先护理计划决策。该项目有三个具体目标： 1. 进行随机对照试验，以检查 AIDS EPC 一揽子干预措施与标准 HIV 护理 (SOC) 的功效，并比较基线后 12 个月的结果。我们的假设是，艾滋病 EPC 组中的患者将获得： i) 更好的临床结果：一年死亡率较低，开始抗逆转录病毒治疗 (ART) 的比例较高，接受病毒学抑制的比例较高，CD4 增益较高，机会性感染 (OI) 较少）、更少的住院治疗、更低的抑郁评分以及更好的症状管理（包括认知功能障碍）。 ii) 更好的心理社会结果：更好的应对技巧、更高的社会支持感知、更高的灵性、更高水平的自我倡导、更低的 报告物质使用情况的比例。 iii) 更好的生活质量 (QOL) 和更高比例的报告预先护理计划活动的人：指定代理人；设定有关救生措施的个人目标；并与代理人讨论了这些目标。 2. 与 SOC 相比，评估 AIDS EPC 包的成本效益和成本效用，其中结果分别被评估为生存期和质量调整生命年 (QALY)。 3. 与 SOC 相比，保持更高比例的预约并报告对护理的满意度更高，这证明了促进艾滋病毒护理的参与和保留。 我们相信，姑息治疗（PC）——重点是支持性、以症状为导向的护理——是优化新诊断艾滋病患者治疗并促进护理参与度和保留率的理想方法。全面、多学科管理的艾滋病 EPC 套餐包括精神、社会、心理、认知和症状管理，此外还每周由护士进行四次一对一动机访谈，以促进疾病调整和有关预先护理计划的决策。我们认为，将 EPC 纳入新诊断艾滋病患者的护理中将大大改善生活质量、临床和心理社会结果，并以比标准护理更低的成本提前制定护理计划。这种护理方法将提高护理的参与度和保留率，并促进个人自我倡导和生活质量的发展。