ENABLE: CHF-PC (Comprehensive Heartcare For Patients and Caregivers)

ENABLE：CHF-PC（针对患者和护理人员的综合心脏护理）

基本信息

批准号：
9001367
负责人：
Marie Anne Bakitas
金额：
$ 68.33万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-02-01 至 2020-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9001367
关键词：
Address Admission activity Advance Care Planning Advanced Malignant Neoplasm Affect Age Alabama American Anxiety Cancer Model Cancer Patient Caregiver Burden Caregivers Caring Cessation of life Characteristics Chronic Disease Communication Consensus Continuity of Patient Care Decision Making Diagnosis Disease Distress Economics Elderly Elements Emergency Situation Emotional Environment Family Family Caregiver Foundations Goals Health Heart Heart failure Hospitalization Hospitals Intervention Joints Knowledge Life Measurable Mediating Mediator of activation protein Medical Medical center Medicare Mental Depression Minority Mission Modeling Moods Morbidity - disease rate Nurses Outcome Palliative Care Participant Patient Care Patient Self-Report Patients Persons Pilot Projects Population Positioning Attribute Problem Solving Procedures Public Health Quality of life Race Randomized Randomized Controlled Trials Reporting Research Resources Risk Factors Rural Rural Population Science Self Care Services Social support Solid Staging Statistical Methods Supportive care Symptoms System Testing Universities Veterans Visit World Health Organization aged base cancer palliative treatment caregiver interventions coping economic cost efficacy testing end of life experience health care delivery health literacy hospice environment human old age (65+)improved innovation instrument intervention effect model design mortality novel older patient outcome forecast palliative pragmatic trial reduce symptoms routine care rural area skills social symptom management telehealth

项目摘要

DESCRIPTION (provided by applicant): Almost 5 million Americans, most over age 65, carry a diagnosis of heart failure (HF). Despite treatment advances, 50% will die within 5 years; increasing age and rural environment are risk factors associated with the greatest HF morbidity and mortality. In the year before death, HF patients will experience multiple hospitalizations and personal and economic costs of unrelieved physical and emotional suffering. Currently, only 19% of Medicare-aged HF patients (and their family caregivers) access beneficial palliative care services, compared with more than half of advanced cancer patients. Older patients with HF and their caregivers, rarely have access to palliative supportive care services because the disease is unpredictable and palliative treatment may not be provided until after other medical treatments have been tried. We and others have demonstrated in advanced cancer that concurrent palliative care achieves beneficial outcomes in quality of life (QOL), symptom burden, depression, and in some case survival. The intervention is adapted from our successful palliative care model for cancer (ENABLE: Educate, Nurture, Advise, Before-Life- Ends). Our overall goal is to test the efficacy of a concurrent HF palliative care model in reducing the morbidity of living with advanced HF. This randomized controlled trial (RCT) will compare the quality of life, symptom burden, mood, and the quality of chronic illness and end-of-life care in 380 older adults with NYHA stage III/IV HF and 228 caregivers. Half of the patient participants (n=190) will be randomized to the intervention and half (n=190) will receive usual HF care. The specific aims of the RCT; ENABLE: CHF-PC (Comprehensive Heart care for Patients and Caregivers), are to 1) Determine whether ENABLE: CHF-PC leads to higher advanced HF patient-reported QOL and mood (depression/anxiety); and lower symptom burden and resource use (e.g. hospital admissions and days, emergency visits) at 8 and 16 weeks after baseline and to 2) Determine whether ENABLE: CHF-PC leads to higher caregiver-reported QOL, mood (anxiety/depression), and self-reported health and lower caregiver burden at 8 and 16 weeks after baseline. The relevance of this research to public health is that there is an urgent need to improve the routine care of older adults in rural areas with advanced heart failure and their caregivers. This study will contribute substantially to that effort.

描述（由适用提供）：近500万美国人，大多数65岁以上，都诊断为心力衰竭（HF）。尽管有治疗的进展，但50％的人仍会在5年内死亡；年龄增长和粗糙环境是与HF发病率最大相关的危险因素。在死亡前的那一年，HF患者将经历多次住院以及不弥补的身体和情感痛苦的个人和经济成本。目前，与一半以上的晚期癌症患者相比，只有19％的医疗治疗HF患者（及其家庭护理人员）获得有益的姑息治疗服务。患有HF及其护理人员的老年患者很少获得姑息治疗服务，因为该疾病是不可预测的，直到尝试其他医疗治疗后才能提供姑息治疗。我们和其他人在晚期癌症中证明，并发姑息治疗可以在生活质量（QOL），症状燃烧，抑郁症以及在某些情况下存活中获得益处。干预措施改编自我们成功的癌症姑息治疗模型（启用：教育，养育，建议，生命前的末端）。我们的总体目标是测试并发的HF姑息治疗模型在降低高级HF生活的发病率方面的效率。这项随机对照试验（RCT）将比较380名NYHA III/IV HF和228名护理人员的380名老年人的生活质量，症状伯恩，情绪和慢性病质量和寿命终止护理的质量。一半的患者参与者（n = 190）将被随机分配给干预措施，一半（n = 190）将获得通常的HF护理。 RCT的具体目的；启用：CHF-PC（患者和看护人的全面心脏保健）是1）确定启用：CHF-PC是否会导致更高的护理人员报告的QOL，情绪（焦虑/抑郁症）以及自我报告的健康状况以及在基线后8和16周时燃烧的较低的照料者燃烧。这项研究与公共卫生的相关性是，迫切需要改善患有高级心力衰竭及其护理人员的粗糙地区老年人的常规护理。这项研究将对这一努力做出重大贡献。