Comparison of home-based palliative care delivered by community health workers versus usual care: research protocol for a pilot randomized controlled trial.
Comparison of home-based palliative care delivered by community health workers versus usual care: research protocol for a pilot randomized controlled trial.
复制标题
DOI：
10.1186/s12904-023-01235-z
复制
发表时间：
2023-09-02
影响因子：
3.1
通讯作者：
Kumar, Gaurav
中科院分区：
文献类型：
--
作者：
Qanungo, Suparna;Cartmell, Kathleen B.;Mueller, Martina;Butcher, Melissa;Sarkar, Saswati;Carlson, Tyler-Gail;Madisetti, Mohan;Kumar, Gaurav
研究表明，姑息治疗可以改善患者的预后，如生活质量、症状负担和患者对护理的满意度（Gomes B等）。家庭姑息治疗服务的有效性和成本效益为成人晚期疾病和他们的照顾者。Cochrane数据库系统修订版，2013(6):CD00776姑息治疗。2020年出版)。虽然76%需要姑息治疗的患者生活在资源有限的国家，但在这些国家获得高质量姑息治疗服务的机会很少（世界临终关怀和姑息治疗协会和世界卫生组织）。全球姑息治疗地图集（第二版）。2020年)。2014年，在世卫组织的大力支持下，世界临终关怀和姑息治疗联盟发布了《姑息治疗工具包》，提供培训和实施工具包，使社区成员能够在资源匮乏的环境中提供姑息治疗（世界临终关怀和姑息治疗协会和世界卫生组织）。临终关怀全球图集。日内瓦，瑞士，2014)。他们鼓励研究人员和公共卫生从业人员在不同的环境和背景下对工具包进行严格的评估。为了满足这一需求，我们将开展一项试点随机对照试验（RCT），以检查基于姑息治疗工具包的干预措施的实施情况，并探索其潜在效果，该工具包已被印度加尔各答一家癌症中心的社区卫生工作者（chw）采用，为农村患者提供以家庭为基础的姑息治疗。采用随机对照试验设计，干预患者（n = 45）接受社区卫生工作者（chw）提供的以家庭为基础的姑息治疗服务（Pal-Care），与对照组（n = 45）接受常规的以癌症中心为基础的姑息治疗服务进行比较。主要结果测量指标包括卫生保健员培训结果的评估、卫生保健员的角色和职责以及他们如何帮助患者、试验招募、利益相关者对干预措施的看法以及对研究方案的忠实度。次要结局衡量患者健康相关生活质量、症状负担、姑息治疗需求和患者护理体验的自我报告。结果RE-AIM框架指导我们的评估计划，以衡量Pal-Care干预的范围、有效性、采用、实施和维持（Gaglio B等）。RE-AIM框架：对长期使用情况的系统回顾。公共卫生杂志，2013;103(6):38?46。数据将在SAS中进行分析。所有措施将根据患者的年龄、性别和癌症类型以及CHW病例量进行总体评估。Pal-Care是由NCI资助的一项随机对照试验，目的是与常规护理对照组相比，探索利用卫生保健工作者提供基于世卫组织姑息治疗工具包（PCT）的家庭姑息治疗干预。本研究的长期目标是开发一种有效和可持续的模式，为服务不足地区的癌症患者提供以家庭为基础的姑息治疗。ClinicalTrials.gov ID# NCT04972630。
Research studies demonstrate that palliative care can improve patient outcomes such as quality of life, symptom burden and patient satisfaction with care (Gomes B, et al. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2013(6):CD00776) (World Health Organization. Palliative Care. Published 2020.). While 76% of patients who need palliative care live in limited-resource countries, access to high quality palliative services in these countries is minimal (Worldwide Hospice and Palliative Care Association and World Health Organization. Global Atlas of Palliative Care (2nd ed). 2020.). In 2014 the Worldwide Hospice Palliative Care Alliance, with strong endorsement by the WHO, released the Palliative Care Toolkit to provide a training and implementation toolkit for empowering community members to deliver palliative care in resource poor settings (Worldwide Hospice and Palliative Care Association and World Health Organization. Global Atlas of Palliative Care at the End of Life. Geneva, Switzerland 2014.). They encouraged researchers and public health practitioners to conduct rigorous evaluation of the toolkit in diverse settings and contexts. To address this need, we will conduct a pilot randomized controlled trial (RCT) to examine implementation and explore potential effect of an intervention based upon the Palliative Care Toolkit, as adapted and used by community health workers (CHWs) working with a cancer center in Kolkata, India to deliver home-based palliative care for rural patients. Utilizing a randomized controlled trial design, intervention patients (n = 45) receive home-based palliative services (Pal-Care) delivered by community health workers (CHWs), with comparison against a control group of patients (n = 45) who receive usual cancer-center-based palliative services. Primary outcome measures include evaluation of CHW training outcomes, roles and responsibilities of the CHWS and how they assist patients, trial recruitment, stakeholder perceptions of the intervention, and fidelity to study protocol. Secondary outcomes measure patient self-report of health-related quality of life, symptom burden, palliative needs and patient care experience, outcomes The RE-AIM framework guides our evaluation plan to measure the reach, effectiveness, adoption, implementation and maintenance of the Pal-Care intervention (Gaglio B, et al. The RE-AIM framework: a systematic review of use over time. Am J Public Health. 2013;103(6):e38?46.). Data will be analyzed in SAS. All measures will be evaluated overall and by patient age, gender and cancer type and by CHW caseload. Pal-Care is a RCT funded by the NCI to explore utilization of CHWs to deliver a home-based palliative care intervention built upon the WHO Palliative Care toolkit (PCT), as compared to a usual care control group. The long-term goal of this research is to develop an effective and sustainable model for delivering home-based palliative care for cancer patients in underserved areas. ClinicalTrials.gov ID# NCT04972630.
登录
查看更多内容
影响因子：
6.9
作者：
Harper, A;Power, M
通讯作者：
Power, M
影响因子：
1.4
作者：
Gomes, Barbara;Calanzani, Natalia;Brito, Maja de
通讯作者：
Brito, Maja de
影响因子：
4.5
作者：
Feroz, Anam;Jabeen, Rawshan;Saleem, Sarah
通讯作者：
Saleem, Sarah
影响因子：
2.8
作者：
Aiken, Leona S.;Butner, Jonathan;Williams, Frank G.
通讯作者：
Williams, Frank G.
影响因子：
--
作者：
CUMMINGS, JE;HUGHES, SL;ADELMAN, J
通讯作者：
ADELMAN, J