Patient-centered and efficacious advance care planning in cancer: the PEACe comparative effectiveness trial

以患者为中心且有效的癌症预先护理计划：PEACe 比较有效性试验

基本信息

批准号：
10569584
负责人：
Yael Schenker
金额：
$ 38.96万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-03-01 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10569584
关键词：
Academy Address Adopted Advance Care Planning Advance Directives Advanced Malignant Neoplasm American American Society of Clinical Oncology Anxiety Attention Behavior Therapy Cancer Center Cancer Patient Caregivers Caring Consensus Data Effectiveness Ensure Failure Family Family Caregiver Future Goals Health system Home Hospitalization Infrastructure International Intervention Intervention Trial Interview Investments Malignant Neoplasms Measures Medicine Methods Modeling Oncology Online Systems Outcome Patient Care Patient Outcomes Assessments Patient Preferences Patient-Centered Care Patients Persons Physicians Public Health Qualitative Evaluations Qualitative Research Quality of Care Reporting Research Research Methodology Resources Single-Blind Study System Time Training Writing anxiety symptoms cancer care care delivery chemotherapy clinical care comparative effectiveness comparative effectiveness trial compare effectiveness comparison intervention cost depressive symptoms design effectiveness evaluation end of life end of life care evidence base experience health care service utilization hospice environment implementation cost implementation evaluation improved innovation patient oriented peace post-traumatic stress preference primary outcome randomized trial relative effectiveness trial comparing

项目摘要

Abstract Summary: Failure to deliver care near the end of life that reflects the needs, values and preferences of patients with advanced cancer remains a key shortcoming of our cancer care delivery system. National organizations including the National Academy of Medicine and American Society of Clinical Oncology have called for increased attention to advance care planning (ACP) to improve patient-centered care near end of life. A critical barrier to progress in the field is a lack of evidence about the most effective and efficient ACP strategy to improve treatment decisions near end of life and ensure patients' wishes are honored. Two different patient-facing ACP interventions are widely used and known to be effective but entail sizeable differences in costs and complexity to deploy: (1) in-person discussions with trained facilitators and (2) web- based advance care planning using interactive videos. These approaches have never been compared directly; it is therefore unclear whether one form of ACP is more potent—and if so, for whom and under what circumstances. Understanding the relative effectiveness of in-person, facilitated versus web-based ACP is important because in-person ACP requires far more resources. This proposal is a single-blind, patient-level randomized trial to address this evidence gap, using mixed methods to compare the effectiveness of in-person, facilitated ACP vs web-based ACP among 400 patients with advanced cancer and their family caregivers. Aim 1 compares the effect of these approaches on patient and family caregiver outcomes (engagement in ACP—primary outcome; ACP discussions with family caregivers and physicians; advance directive (AD) completion; and caregiver symptoms of depression and anxiety). For patients who die during the study period, we will use validated, caregiver-reported measures to compare perceived quality of EOL care, patients' EOL goal attainment, and bereaved caregiver symptoms of depression, anxiety and post-traumatic stress. Aim 2 assesses implementation costs of each intervention and effects on healthcare utilization at end of life. Aim 3 identifies contexts and mechanisms influencing the effectiveness of each approach. This trial will have a high impact because it will provide new and much-needed empirical evidence about two patient-facing ACP approaches that successfully overcome limitations of traditional written advance directives but entail very different investments of time and resources. It is innovative in using mixed methods to evaluate not only the comparative effectiveness of these approaches, but also for whom, how and in what circumstances they are effective. It is feasible because it builds on extensive infrastructure developed by an accomplished research team with experience conducting behavioral intervention trials and qualitative research in ACP and oncology.

摘要摘要：未能在生命即将结束时提供反映患者需求、价值观和偏好的护理晚期癌症仍然是我们国家组织癌症护理服务系统的一个主要缺点。包括美国国家医学院和美国临床肿瘤学会在内的组织呼吁加强对预先护理计划 (ACP) 的关注，以改善临终时以患者为中心的护理。该领域取得进展的障碍是缺乏关于最有效和高效的 ACP 策略的证据改善临终时的治疗决策并确保患者的愿望得到尊重。两种不同的面向患者的 ACP 干预措施被广泛使用，并且众所周知是有效的，但需要相当大的成本部署成本和复杂性的差异：(1) 与训练有素的协调员进行面对面讨论，以及 (2) 网络这些方法从未被直接比较过；因此，尚不清楚一种形式的 ACP 是否更有效，如果是，对于谁以及在什么情况下更有效了解面对面、便利的 ACP 与基于网络的 ACP 的相对有效性是很重要的。重要的是，因为面对面的 ACP 需要更多的资源。该提案是一项单盲、患者水平的随机试验，旨在解决这一证据差距，使用混合比较 400 名患有以下疾病的患者进行现场辅助 ACP 与基于网络的 ACP 的有效性的方法目标 1 比较了这些方法对晚期癌症及其家庭护理人员的影响。家庭照顾者的结果（参与 ACP——主要结果；与家庭照顾者的 ACP 讨论以及预先指示 (AD) 完成；以及照顾者的抑郁和焦虑症状）。对于在研究期间死亡的患者，我们将使用经过验证的、护理人员报告的措施来比较 EOL 护理的感知质量、患者的 EOL 目标实现情况以及失去亲人的护理人员的抑郁症状，目标 2 评估每项干预措施的实施成本及其影响。目标 3 影响临终医疗保健有效性的背景和机制。每种方法。这项试验将产生很大的影响，因为它将提供关于两个方面的新的、急需的经验证据面向患者的 ACP 方法成功克服了传统书面预先医疗指示的局限性但需要投入非常不同的时间和资源，使用混合方法来实现这一点是创新的。不仅要评估这些方法的比较有效性，还要评估针对谁、如何以及在什么方面在某些情况下它们是有效的，因为它建立在由一个组织开发的广泛基础设施之上。经验丰富的研究团队，具有进行行为干预试验和定性研究的经验在 ACP 和肿瘤学领域。