Lessons from the field: challenges in accruing hospice heart failure patients to intervention research.
Lessons from the field: challenges in accruing hospice heart failure patients to intervention research.
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DOI：
10.1097/jcn.0b013e3182784cc0
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发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
McMillan SC
中科院分区：
文献类型：
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作者：
Zambroski CH;Buck H;Garrison CM;McMillan SC
最近的临床实践指南表明，临终关怀对于晚期心力衰竭（HF）患者来说是一种有价值的选择。不幸的是，很少有循证护理干预措施来指导临终关怀中心的心力衰竭患者及其护理人员的症状管理。然而，在临终关怀人群中进行临床研究仍然充满了方法论和伦理方面的挑战。我们的研究团队并不天真地认识到临终关怀研究是困难的。我们相信，在临床试验开始测试向心力衰竭患者的护理人员提供心理社会干预的可行性之前，我们已经为一些突发事件做好了充分的准备。尽管团队拥有专业知识和明确的招聘策略，但该人群的招聘（无论是应计还是自然流失）仍然令人望而生畏。本文的目的是报告招募心力衰竭临终关怀患者和护理人员参加我们的随机临床试验所面临的挑战，包括我们预期的和未预期的。背景美国各地临终关怀中心患有心力衰竭 (HF) 并死于心力衰竭 (HF) 的患者数量不断增加。 1 在过去 20 年中，临终关怀患者群体发生了重大转变，从主要患有癌症相关诊断的患者转向患有慢性疾病的患者；在 158 万患者中，约 14% 被诊断患有心脏病，包括心力衰竭。 1 尽管入住临终关怀中心的心力衰竭患者百分比保持相对稳定，但随着全国临终关怀中心数量的不断增加，接受此类护理的心力衰竭患者数量不断增加，绝对数量有所增加。 1
Recent clinical practice guidelines suggest that hospice can be a valuable alternative for patients with advanced heart failure (HF). Unfortunately, there are very few evidence-based nursing interventions to guide symptom management for HF patients in hospice and their caregivers. Nevertheless, conducting clinical research in hospice populations remains fraught with methodological and ethical challenges. Our research team was not naive to the fact that hospice research is difficult. We believed that we had prepared well for a number of contingencies before the beginning of our clinical trial testing the feasibility of delivering a psychosocial intervention to caregivers of patients with HF. Despite the team expertise and well-defined recruitment strategies, the recruitment, both accrual and attrition, remained daunting in this population. The purpose of this article was to report the challenges of recruiting hospice patients with HF and caregivers for our randomized clinical trial, those we anticipated and those we did not.BackgroundGrowing numbers of patients in hospices across the United States are living with and dying of heart failure (HF). 1 Over the past 2 decades, there has been a significant shift in the hospice patient population from those primarily with cancer-related diagnoses to those of chronic illnesses; of 1.58 million patients, approximately 14% are diagnosed with cardiac diseases, including HF. 1 Whereas the percentage of HF patients admitted to hospice remains relatively steady, the absolute number has increased as growing numbers of hospices across the country contribute to the escalating numbers of HF patients receiving this type of care. 1