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: 7320057
• 负责人: Barbara Daly
• 金额: $ 47.53万
• 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 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7320057
• 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; Decision Making; Diagnostic Neoplasm Staging; Disease; Disease Management; Disease remission; Effectiveness; Enrollment; Family; Fostering; Goals; Guidelines; Hospice Care; 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; Numbers; Operative Surgical Procedures; Outcome; Ovarian; Pain management; Palliative Care; Pancreas; Patient Care; Patients; Personal Satisfaction; Persons; Phase; Philosophy; Prevention; Problem Solving; Process; Protocols documentation; Provider; Purpose; Quality of Care; Quality of life; Relative (related person); Research; Resources; Services; Specialist; Staging; Symptoms; System; Testing; Therapeutic; Time; Visit; base; cancer care; cancer therapy; care delivery; care giving burden; chemotherapy; day; design; desire; end of life; end of life care; experience; health related quality of life; hospice environment; improved; interdisciplinary collaboration; patient home care; preference; programs; psychologic; psychosocial; satisfaction; skills; symptom management; 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）：晚期癌症患者需要获得以治愈为导向的治疗和姑息治疗。国家综合癌症网络 (NCCN) 将姑息治疗的目标确定为预防和减轻痛苦，无论疾病处于哪个阶段，也无论姑息治疗是与延长生命的护理同时提供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并关注癌症经历的心理社会方面，但患者仍然发现姑息治疗和临终关怀方面的缺点，包括缺乏协调和沟通、难以获得护理、症状管理不足，并延长死亡过程。重大改进需要改变护理服务系统，以确保：(a) 患者能够获得针对身体、心理和精神需求的专家管理以及出色的治疗方法 (b) 患者家属得到同样的专家支持； (c) 随时可以接触到有技能和时间的专业人员，帮助患者及其家人从治愈的主要目标过渡到姑息治疗的主要目标； (d) 向社区提供者协调过渡，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服务模式，尽管它从未在学术癌症中心进行过测试。本调查的目的是实施综合疾病管理计划（DMP），衡量对晚期癌症患者及其家人的生活质量和护理质量的影响，并检查对资源利用的影响。将采用两组、准实验、串联注册设计。研究问题是：（1）参与过的晚期癌症患者的资源使用（生命最后30天的化疗次数、急诊室就诊次数、临终关怀和住院天数）是否存在差异？与接受常规护理的患者相比，DMP 有何不同？ (2) 与接受常规护理的晚期癌症患者相比，参加 DMP 的晚期癌症患者的患者结局（健康相关的生活质量、精神健康、护理满意度）是否存在差异？ (3) 与接受常规护理的晚期癌症患者的护理人员相比，参与 DMP 的晚期癌症患者的护理结果（情绪状态、护理满意度、临终护理满意度和护理负担）是否存在差异？ (4) 在控制人口、临床和组织协变量的影响后，患者和护理人员结果的差异是否仍然存在？ (5) 通过改进协作和解决问题，患者和护理人员的结果在多大程度上实现了差异？