Palliative Care for Hospitalized Cancer Patients

住院癌症患者的姑息治疗

基本信息

批准号：
7676834
负责人：
DIANE E MEIER
金额：
$ 149.65万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-09-30 至 2011-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7676834
关键词：
Abbreviations Accreditation Achievement Adopted Adult Advance Care Planning Advanced Malignant Neoplasm Algorithms American Society of Clinical Oncology Analgesics Cancer Patient Caring Cessation of life Chronic Disease Clinical Communication Consultations Decision Making Distress Documentation Evidence based treatment Family Goals Guidelines Healthcare Hospital Costs Hospitals Individual Intensive Care Units Intervention Length Length of Stay Life Link Malignant Neoplasms Medical National Comprehensive Cancer Network Outcome Pain Palliative Care Patient Care Team Patients Persons Practice Guidelines Process Process Measure Protocols documentation Quality Indicator Resources Scoring Method Selection Bias Services Site Structure Symptoms Treatment Protocols United States Work base control trial design evidence base hospital readmission hospital utilization improved instrument novel preference programs psychologic satisfaction social symptom management treatment as usual

项目摘要

DESCRIPTION (provided by applicant): The purpose of this study is to evaluate the clinical outcomes of palliative care consultation teams on the care of hospitalized patients with advanced cancer. Repeated studies have demonstrated high rates of untreated symptom distress, poor doctor-patient communication about the goals of medical care and high levels of fragmentation and discontinuity of medical care between settings. Palliative care consultation teams have been shown in small preliminary studies to improve the identification and treatment of pain and symptoms; to increase the occurrence of goal setting discussions and appropriate discharge planning; and to improve family satisfaction with care. However, these studies have not explicated the structures and processes of care linked to the achievement of these outcomes. This proposal will assess the structure, processes, and clinical outcomes of care among hospitalized persons with advanced cancer that receive palliative care consultation team services as compared to similar patients receiving usual hospital care. We will accomplish this by studying an evidence-based standardized approach to palliative care consultation at five hospitals with well-established palliative care consultation teams, utilizing existing National Comprehensive Cancer Network-American Society of Clinical Oncology practice guidelines and protocols for pain and symptom management, patient-care team communication, and transition management. Employing validated and actionable assessment instruments, we will examine the effect of palliative care consultation teams on patient and family outcomes (pain and symptom intensity, satisfaction with care), process measures (analgesic prescribing, symptom assessment, goals of care discussions, care transition management, and advance care planning), and utilization (hospital and ICU lengths of stay, hospital readmission, and hospital costs) compared to usual care for adults hospitalized with advanced malignancies. We propose to accomplish these aims by conducting a multi-site observational controlled trial of palliative care consultation with adequate power to detect clinically meaningful differences using a novel application of the propensity score method to reduce selection bias. Reproducible structures and processes for the PCCTs will allow successful components of the program to be readily adopted and operationalized at a range of hospital types.

描述（由申请人提供）：本研究的目的是评估姑息治疗咨询团队对晚期癌症住院患者护理的临床结果。反复的研究表明，未经治疗的症状困扰的比例很高，医患关于医疗保健目标的沟通不畅，以及不同环境之间医疗保健的高度分散和不连续性。小型初步研究表明，姑息治疗咨询团队可以改善疼痛和症状的识别和治疗；增加目标设定讨论和适当的出院计划的发生；并提高家庭对护理的满意度。然而，这些研究并未阐明与实现这些结果相关的护理结构和过程。该提案将评估接受姑息治疗咨询团队服务的晚期癌症住院患者的护理结构、流程和临床结果，与接受常规医院护理的类似患者进行比较。我们将通过在五家拥有完善的姑息治疗咨询团队的医院研究基于证据的姑息治疗咨询标准化方法，利用现有的国家综合癌症网络-美国临床肿瘤学会疼痛和症状管理实践指南和协议来实现这一目标，患者护理团队沟通和过渡管理。采用经过验证和可操作的评估工具，我们将检查姑息治疗咨询团队对患者和家庭结果（疼痛和症状强度、护理满意度）、过程测量（镇痛处方、症状评估、护理讨论目标、护理过渡管理）的影响和预先护理计划）以及利用率（医院和 ICU 住院时间、再入院和住院费用）与晚期恶性肿瘤住院成人的常规护理相比。我们建议通过进行姑息治疗咨询的多中心观察性对照试验来实现这些目标，该试验具有足够的能力，使用倾向评分方法的新颖应用来检测临床上有意义的差异，以减少选择偏差。 PCCT 的可重复结构和流程将使该计划的成功组成部分能够在各种类型的医院中轻松采用和实施。