Palliative Care Symptom Management in Rural Communities

农村社区姑息治疗症状管理

基本信息

批准号：
8690622
负责人：
Ardith Z Doorenbos
金额：
$ 38.74万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-12 至 2016-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8690622
关键词：
Address Anxiety Attitude Cancer Patient Caregivers Caring Case Management Chronic Clinical Clinical Trials Design Communication Communities Competence Constipation Consultations Control Groups Distant Distress Dyspnea Effectiveness Effectiveness of Interventions Evidence based practice Experimental Designs Face Family member Fatigue Financial cost Goals Health Health Care Visit Health Personnel Health Services Healthcare Home Care Services Home environment Improve Access Intervention Knowledge Life Link Mental Depression Methods Modeling Outcome Outcome Study Pain Palliative Care Patient Care Patient Participation Patient Self-Report Patients Population Density Poverty Provider Quality of life Quality-Adjusted Life Years Randomized Randomized Clinical Trials Reporting Research Research Infrastructure Resources Rural Rural Community Rural Health Rural Population Self Assessment Services Severities Solutions Specialist Symptoms Technology Testing Time Training Support Travel Underinsured Uninsured United States Videoconferences Videoconferencing Visit care delivery case-based cost cost effective cost effectiveness disability effective intervention evidence base group intervention health care delivery health care service utilization health disparity improved intervention effect medical specialist medical specialties palliative peer programs randomized trial rural area symposium symptom management telehealth

项目摘要

DESCRIPTION (provided by applicant): Palliative care aims to provide relief of pain and other patient symptoms, such as fatigue, dyspnea, constipation, anxiety, and depression, in order to improve quality of life. Patients in isolated rural settings often lack easy access to palliative care and other specialist services. Yet rural residents are more likely than their urban counterparts to be older; be in poorer overall health; suffer from more chronic or serious illnesses and disabilities; be uninsured or underinsured; and live in poverty. Telehealth is an emerging method of health care delivery that has been found useful and effective in many clinical settings and specialties. Telehealth technologies can bridge geographic distance and increase access to specialist care in rural settings. We propose a cluster randomized clinical trial design to test the effects of a telehealth-enhanced palliative care symptom-management program for 288 cancer patients and 96 providers in rural health care settings. The proposed program will provide services to both patients and providers: Patients will conduct self-assessments and report pain and other symptoms via telehealth. Health care providers will receive telehealth-delivered case consultations that will include case management, evidence-based practice resources, and peer support. Providers and their patients will be randomly assigned to intervention groups, which receive the telehealth- enhanced palliative care symptom-management intervention, or to control groups. Our primary aim is to compare patient self-reports of symptoms and quality of life in the intervention and control groups over 2 months. Aim 2 is to examine, in the intervention and control groups over 2 months, providers' knowledge and attitudes regarding symptoms and perceived competence in treating symptoms. Aim 3 is to evaluate the cost- effectiveness of the telehealth intervention. We will use mixed effects models with patients nested within providers to evaluate the effect of the intervention on study outcomes. Findings from this study will be instrumental in advancing telehealth and improving symptom management and palliative care among underserved rural populations.

描述（由申请人提供）：姑息治疗旨在缓解疼痛和其他患者症状，如疲劳、呼吸困难、便秘、焦虑和抑郁，以提高生活质量。偏远农村地区的患者往往难以轻易获得姑息治疗和其他专科服务。然而，农村居民比城市居民的年龄更大；整体健康状况较差；患有更慢性或严重的疾病和残疾；没有保险或保险不足；并生活在贫困之中。远程医疗是一种新兴的医疗保健提供方法，已在许多临床环境和专业中证明有用且有效。远程医疗技术可以弥合地理距离并增加农村地区获得专科护理的机会。我们提出了一项整群随机临床试验设计，以测试远程医疗增强姑息治疗症状管理计划对农村医疗机构中 288 名癌症患者和 96 名提供者的效果。拟议的计划将为患者和提供者提供服务：患者将进行自我评估并通过远程医疗报告疼痛和其他症状。医疗保健提供者将接受远程医疗提供的病例咨询，其中包括病例管理、循证实践资源和同行支持。提供者及其患者将被随机分配到接受远程医疗增强姑息治疗症状管理干预的干预组或对照组。我们的主要目的是比较干预组和对照组患者在两个月内的症状和生活质量自我报告。目标 2 是在 2 个月内检查干预组和对照组中提供者对症状的知识和态度以及治疗症状的感知能力。目标 3 是评估远程医疗干预的成本效益。我们将使用混合效应模型，将患者嵌套在提供者中，以评估干预措施对研究结果的影响。这项研究的结果将有助于推进远程医疗、改善服务不足的农村人口的症状管理和姑息治疗。