A Nurse-Led Palliative and Supportive Care Intervention for Newly Diagnosed Adults with Acute Myeloid Leukemia

针对新诊断的急性髓系白血病成人的护士主导的姑息和支持护理干预措施

• 批准号: 10368993
• 负责人: Ashley Leak Bryant
• 金额: $ 19.44万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-09 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10368993
• 关键词: Acute Myelocytic Leukemia; Address; Adult; Adverse event; Affect; Aftercare; Age-Years; Ambulatory Care Facilities; Anxiety; Caregivers; Caring; Chronic; Chronic Disease; Clinical; Clinical Practice Guideline; Cognition; Data; Data Collection; Deterioration; Development; Diagnosis; Discipline of Nursing; Disease; Elderly; Emotional; Enrollment; Fatigue; Foundations; Freedom; Future; Goals; Hematologic Neoplasms; Home; Hospitalization; Hospitals; Hour; Independent Living; Infection; Infrastructure; Infusion procedures; Institutional Review Boards; Intervention; Intervention Studies; Interview; Knowledge; Leadership; Length of Stay; Life; Malignant Neoplasms; Manuals; Measures; Methods; Modeling; Monitor; Motivation; Movement; Newly Diagnosed; Nurses; Occupational Therapy; Oncology; Oral; Outcome; Outpatients; Pain; Palliative Care; Patient Self-Report; Patients; Persons; Physical therapy; Prevention; Prize; Procedures; Prognosis; Protocols documentation; Quality of life; Randomized Clinical Trials; Randomized Controlled Trials; Readiness; Recommendation; Regimen; Registered nurse; Reporting; Self Management; Site; Sleep disturbances; Specific qualifier value; Supportive care; Surveys; Symptoms; Test Result; Testing; Therapeutic Intervention; Time; Training; Treatment Efficacy; Walking; Work; Workload; Writing; acceptability and feasibility; acute care; base; cancer therapy; chemotherapy; collaborative care; daily functioning; data management; depressive symptoms; design; efficacy trial; end of life; exercise intervention; experience; functional decline; health care service utilization; high risk; hospital readmission; improved; improved functioning; leukemia treatment; medical specialties; mortality risk; novel; nursing intervention; operation; psychologic; recruit; reduce symptoms; retention rate; skills; social; standard care; symptom management; symptom self management; treatment duration

7. PROJECT SUMMARY/ABSTRACT Acute myeloid leukemia (AML) is a serious illness of older adults (>60) which carries a high risk of mortality and negatively impacts daily function and quality of life (QOL). Prognosis is poor; over two-thirds of patients will not survive 5 years. Recently, approval of oral venetoclax (VEN) in addition to infusional hypomethylating agents (HMAs) has improved treatment efficacy substantially for older adults, and protocols now typically are to receive the first cycle of treatment during 7 days in the hospital and then return home for 21 days of treatment with caregivers more actively involved. Patients are at high risk for fatigue, which leads to functional decline and subsequent deterioration in quality of life (QOL), interfering with their return to independent living. We propose to address symptoms and function management early in AML treatment using a PAlliative and Collaborative Care inTervention (PACT) delivered by clinical staff who receive basic training in palliative and supportive care to bridge this gap in care and address QOL. Patients highly prize freedom from symptoms and ability to move about as important aspects of QOL. Accordingly, PACT targets symptom management and prevention of functional decline as mechanisms through which QOL is supported. PACT is an interdisciplinary nurse-led intervention of nursing [RN], occupational therapy [OT], physical therapy [PT] for adults ≥ 60 years of age to begin within two days of hospital admission. Guided by the Adaptive Leadership Framework for Chronic Illness, the PACT team works with the patient to assess and manage their symptoms (e.g. anxiety, depressive symptoms, pain, fatigue, sleep disturbance, cognition) and to optimize function (e.g Activity Measure for Post- Acute Care, function) to address QOL outcomes (i.e. symptoms, function domains). PACT empowers patients with self-management skills to reduce symptoms and optimize function during this period of serious illness. The team and patient identify and address emotional, motivational, attitudinal barriers so that the patient can do the work required for self- management to reduce symptoms and avoid functional decline. Our primary objective is to assess feasibility, acceptability, and change in pre and post measures of QOL, symptoms, function, and readiness for discharge in 2 cycles (total of 60 days) of HMA + VEN regimen. We propose a two-year planning project with these aims: 1) Determine feasibility and acceptability of study methods and examine changes in pre- and post- treatment measures of function, patients' self-report of symptoms and QOL, and patients and caregivers' post self-report of readiness for discharge. We will include 10 control and 10 intervention patients, and 2) Develop and write R01 proposal based on what is learned from Aim 1. Finalize protocol, establish study infrastructure including expanding interdisciplinary team; identify and enroll R01 sites, refine recruitment strategy and operations procedures, procedures manual, and quality and data management plan; and obtain IRB approval for the randomized controlled trial (RCT) R01. We address NINR's End-of-Life and Palliative Care priorities.

7。项目摘要/摘要 急性髓样白血病（AML）是老年人的严重疾病（> 60），其死亡率很高和 负面影响日常工作和生活质量（QOL）。预后很差；超过三分之二的患者不会 生存5年。最近，除了输注的低甲基化剂外，批准口服Venetoclax（VEN） （HMAS）已大大提高了老年人的治疗效率，现在方案通常要接受 医院7天内的第一个治疗周期，然后返回家中21天的治疗 护理人员更积极参与。患者有疲劳的高风险，这会导致功能下降和 随后的生活质量（QOL）恶化，干扰了他们重返独立生活。我们建议 使用姑息和协作的AML治疗早期解决症状和功能管理 临床人员提供的护理干预措施（PACT）接受姑息和支持护理的基础培训 在护理中弥合这一差距并解决QOL。患者高度高度免于症状和移动能力 大约是QOL的重要方面。彼此之间，契约针对符合管理和预防 功能下降作为支持QOL的机制。协议是跨学科护士主导的 护士的干预[RN]，职业治疗[OT]，物理治疗[PT]成人≥60岁的成人 在入院后的两天内开始。在慢性病的自适应领导框架的指导下， 协议团队与患者合作评估和管理症状（例如焦虑，抑郁症 症状，疼痛，疲劳，睡眠障碍，认知）并优化功能（例如 急性护理，功能）以解决QoL结果（即征血，功能域）。协定赋予患者 凭借自我管理能力减轻症状并在严重疾病的这一时期优化功能。这 团队和患者认同并解决情感，动机，态度障碍，以便患者可以做 自我管理需要减少症状并避免功能下降所需的工作。我们的主要目标是 评估QOL，症状，功能和后措施的可行性，可接受性和变化 HMA + VEN方案的2个周期（总计60天）的出院准备。我们提出了为期两年的计划 以这些目的为目标：1）确定研究方法的可行性和可接受性并检查 功能前后的治疗措施，患者的符号和生活质量的自我报告以及患者以及 护理人员的发表文章准备出院。我们将包括10名对照和10名干预患者， 2）根据AIM 1中学到的内容制定和写R01提案。最终确定协议，建立研究 基础设施，包括扩大跨学科团队；识别和注册R01站点，完善招聘 策略和操作程序，手册以及质量和数据管理计划；并获得 IRB批准随机对照试验（RCT）R01。我们解决忍者的临终关怀和姑息治疗 优先事项。

项目成果

Exploring Experiences of Bereaved Caregivers of Older Adult Patients With Acute Myeloid Leukemia.

• DOI: 10.1188/22.cjon.135-139
• 发表时间: 2022-04-01
• 期刊: CLINICAL JOURNAL OF ONCOLOGY NURSING
• 影响因子: 1.1
• 作者: Poor, Elissa;Chan, Ya-Ning;Iadonisi, Katie;Tan, Kelly;Bryant, Ashley Leak
• 通讯作者: Bryant, Ashley Leak