Mapping Multidimensional Illness Trajectories of Patients With ESKD

绘制 ESKD 患者的多维疾病轨迹

• 批准号: 8257799
• 负责人: MI-KYUNG SONG
• 金额: $ 43.16万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-27 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8257799
• 关键词: Acute; Acute myocardial infarction; Amputation; Caring; Cause of Death; Cessation of life; Comorbidity; Complex; Data; Development; Dialysis procedure; Dimensions; Emotional; End stage renal failure; Event; Healthcare; Hemorrhage; Intervention; Life; Limb structure; Maintenance; Malignant Neoplasms; Maps; Measures; Modeling; Organ failure; Pain; Palliative Care; Patients; Pattern; Personal Satisfaction; Physical Function; Population; Quality of life; Research; Risk; Sampling; Sepsis; Stroke; Symptoms; Techniques; Time; Wit; burden of illness; cancer type; design; end of life; experience; high risk; improved; meetings; mortality; palliative; patient population; prospective; psychosocial; response

DESCRIPTION (provided by applicant): The number of patients with end-stage kidney disease (ESKD) requiring maintenance dialysis is increasing rapidly in the U.S. ESKD is typically accompanied by multiple co-morbidities, including other organ failure. Complications are common, and they undermine survival and quality of life. When acute illnesses are superimposed on co-morbidities, they typically cause death. Few escape acute life-threatening episodes; yet little is known about the trajectories of symptoms, physical functioning, psychosocial needs, and emotional and spiritual well-being of patients with ESKD when they experience acute life-threatening episodes. Such data are in great need to guide palliative care for this population. This proposed study will therefore identify trajectories of symptoms, physical functioning, psychosocial needs, and emotional and spiritual well-being in a sample of 200 patients with ESKD who are at a high risk of experiencing acute life-threatening events and mortality within 12 months. Specific aims are to (1) identify longitudinal patterns of the five dimensions of quality of life, i.e., symptoms, physical functioning, psychosocial needs, and emotional and spiritual well- being of patients with ESKD who experience acute life-threatening events; (2) examine the relationships among these five dimensions of quality of life over time and the impact of acute life-threatening events on the relationships; and (3) examine the relationships of trajectories of the five dimensions to survival. This study will use a prospective descriptive design with repeated measures over 12 months, or until patient death. The five dimensions of quality of life will be assessed monthly. A linear mixed model will be used as the primary statistical technique for assessing the longitudinal patterns of the five dimensions of quality of life and the relationships among the repeated measures and multiple predictors of each dimension. This study will provide data to help identify and meet the complex needs of patients with ESKD who experience acute life-threatening events superimposed on the demands of dialysis and co-morbidities. PUBLIC HEALTH RELEVANCE: Patients with end-stage kidney disease (ESKD) must manage not only the demands of dialysis and co-morbid conditions but also associated symptoms and acute life-threatening events that contribute to functional limitations and increased risk of mortality. Yet little is known about the trajectories of quality of life dimensions in patients wit ESKD when they experience acute life-threatening episodes, to guide palliative care for this population. In this prospective, descriptive study, we will identify trajectories of symptoms, physical functioning, psychosocial needs, and emotional and spiritual well-being in 200 patients with ESKD who are at a high risk of experiencing acute life-threatening events and mortality within 12 months.

描述（由申请人提供）：美国ESKD中需要维持透析的终末期肾脏疾病（ESKD）的患者数量迅速增加，通常伴随着多种合并症，包括其他器官衰竭。并发症很常见，它们破坏了生存和生活质量。当急性疾病因合并症叠加时，它们通常会导致死亡。很少有急性威胁生命的情节；然而，对于ESKD患者的症状，身体功能，社会心理需求以及情感和精神福祉的轨迹，当他们经历严重威胁生命的情节时，知之甚少。这些数据非常需要指导该人群的姑息治疗。因此，这项拟议的研究将确定症状的轨迹，身体 在200例ESKD患者中，有功能，社会心理需求以及情感和精神上的幸福感，他们在12个月内遇到急性威胁生命的事件和死亡率的高风险。具体目的是（1）确定生活质量五个维度的纵向模式，即症状，身体功能，社会心理需求以及经历急性威胁生命事件的ESKD患者的情感和精神福祉； （2）检查生活质量的这五个维度随着时间的推移以及急性威胁生命的事件对关系的影响； （3）检查五个维度与生存的轨迹的关系。这项研究将在12个月内或直到患者死亡之前使用前瞻性描述性设计，并进行重复措施。生活质量的五个维度将每月评估。线性混合模型将用作评估生活质量五个维度的纵向模式以及重复度量和每个维度的多个预测指标之间的纵向模式。这项研究将提供数据，以帮助识别并满足ESKD患者的复杂需求，这些患者经历了急性威胁生命的事件，这些事件叠加于透析和合并症的需求。 公共卫生相关性：终阶段肾脏疾病（ESKD）的患者不仅必须管理透析和合并症的需求，还必须管理症状和急性威胁生命的事件，这导致功能限制和增加死亡风险。然而，对于ESKD患者的生活质量维度的轨迹却一无所知，当他们经历急性威胁生命的发作，以指导该人群的姑息治疗。在这项前瞻性的描述性研究中，我们将确定200例ESKD患者的症状，身体机能，社会心理需求以及情感和精神健康的轨迹，他们在12个月内有急性威胁生命的事件和死亡率的高风险。