Palliative care algorithms for HF dyads: 1-year versus 2-year predicted survival

心衰二元组的姑息治疗算法：1 年与 2 年预测生存率

• 批准号: 8521390
• 负责人: Judith E Hupcey
• 金额: $ 39.67万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-26 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8521390
• 关键词: Acute; Address; Admission activity; Affect; Age; Algorithms; American; Area; Caregivers; Caring; Cessation of life; Characteristics; Decision Making; Demographic Aging; Diagnosis; Emotional; Enrollment; Evidence based practice; Face; Family Caregiver; Family Practice; Gender; General Population; Grief reaction; Guidelines; Health; Health system; Heart; Heart Diseases; Heart failure; Hospitals; Internal Medicine; Intervention; Interview; Knowledge; Life; Life Experience; Long-Term Care; Longitudinal Studies; Medical; Medical center; Modeling; Palliative Care; Patients; Pattern; Philosophy; Physiological; Population; Population Heterogeneity; Quality of life; Race; Recruitment Activity; Refractory; Risk; Rural; Sampling; Services; Site; Specific qualifier value; Spouse Caregiver; Spouses; Staging; Sudden Death; Supportive care; Symptoms; System; Terminal Disease; Testing; Time; Translations; United States; Variant; Work; advanced disease; base; care delivery; clinical practice; coping; design; experience; health care delivery; hospice environment; inner city; meetings; palliative; racial and ethnic; suburb

DESCRIPTION (provided by applicant): Almost 6 million Americans live with heart failure with 1/2 million new cases diagnosed each year. Within the first year of diagnosis 1 in 5 will die, with 80% dying within 8 years of diagnosis. Yet, less than 10% of patients are offered supportive or palliative care services beyond basic medical care. This proposal aims to fill the gap in our knowledge about the experience of living with heart failure in patient-caregiver dyads by exploring the unique needs of these dyads with 1-year or 2-year predicted survival with various patterns of medical instability and medical stability across the terminal heart failure trajectory and across two care delivery systems with diverse populations. The specific aims are: 1) To identify the critical variations in palliative care needs of patient-caregiver dyads between patients with a 1-year predicted survival and a 2-year predicted survival including variations in patterns of medical instability and medical stability, care delivery systems, and population demographics (age, gender, ethnic/racial) and 2) To develop an algorithm that specifies type and timing of individualized palliative care interventions to meet the needs of patient-caregiver dyads based on variations across the terminal heart failure trajectory. One hundred patient-caregiver dyads (total sample n=200 [patients and caregivers]) who are followed in internal medicine/family practice sites at two healthcare delivery systems: Penn State Hershey Medical Center and Harrisburg Hospital, Pinnacle Health Systems, will be recruited. Fifty patients and their caregivers that have a 1-year predicted survival and 50 patients and their caregivers with a 2-year predicted survival will be enrolled. Dyads will be interviewed monthly for up to 24 months (or until the death of the patient) to explore the palliative care needs of these dyads as they traverse the terminal heart failure trajectory. At the conclusion of this project, we will have thik, rich descriptions of the terminal heart failure experience including the dyad's palliative care needs, which needs were met and which have not been addressed, which types of palliative care interventions were offered and accepted, timing of interventions, and areas to be explored in terms of new interventions to meet these needs. We will make a significant contribution to evidence-based practice by building an algorithm available for translation into clinical practice a a guideline for targeted palliative care interventions for heart failure patient-caregiver dyads. This algorithm should be able to guide interventions based on predicted survival, 1-year versus 2-year and other characteristics of the patient, caregiver, and the dyad as a whole. This algorithm will be ready to be tested along with palliative care intervention in a supportive clinicl trial with a larger and more diverse population of heart failure patient-caregiver dyads.

描述（由申请人提供）：近600万美国人患有心力衰竭，每年被诊断出1/20万个新病例。在诊断的第一年内，第1名将死亡， 80％在诊断的8年内死亡。然而，除了基本医疗服务之外，只有不到10％的患者获得了支持或姑息治疗服务。该提案旨在通过探索这些二元组的独特需求，这些二元组具有1年或2年的预测生存，并在最终心力衰竭轨迹中具有各种医疗不稳定模式，以及在两个有多样性的人群中，各种医疗不稳定性和医疗稳定性。具体目的是：1）确定患者照顾者的姑息治疗需求的关键差异是具有1年预测生存的患者之间的二型二型，以及2年预测的生存期，包括医疗不稳定和医疗稳定性，护理服务系统和人群人口统计学和人群人群的差异（年龄，性别，种族/种族），并开发出algifities的特殊性，并培养了algifities的特殊性，并提高了态度的特定类型。基于整个末端心力衰竭轨迹的变化，患者护理人员二元组的需求。在两个医疗保健提供系统的内科/家庭练习场中遵循的一百名患者保养二元组（总样本n = 200 [患者和护理人员]）将招募宾夕法尼亚州立医院和哈里斯堡医院，Pinnacle Health Systems。有50名患者及其护理人员预测生存期为1年，50名患者及其护理人员将招募2年的生存期。二元组将每月接受24个月（或直到患者死亡）每月进行采访，以探索这些二元组穿越终末心力衰竭轨迹的姑息治疗需求。在该项目的结论结束时，我们将对Thik进行最终心力衰竭经验的丰富描述，包括Dyad的姑息治疗需求，满足且尚未解决的需求，提供和接受的姑息治疗干预措施，干预时间，干预时间，以及在满足这些需求的新干预措施方面进行探索。我们将通过构建可转化为临床实践的算法为基于证据的实践做出重大贡献，这是针对心力衰竭患者护理人员二元组的针对性姑息治疗干预措施的指南。该算法应该能够根据预测的生存，1年对患者，护理人员和整个Dyad的特征进行指导干预措施。该算法将准备好在一项支持性诊所试验中与姑息治疗干预一起进行测试，其中更大，更多样化的心力衰竭患者护理人员二元组。