Improving hospice outcomes through systematic assessment: a clinical trial.
Improving hospice outcomes through systematic assessment: a clinical trial.
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DOI：
10.1097/ncc.0b013e3181f70aee
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发表时间：
2011-03
期刊：
影响因子：
2.6
通讯作者：
Haley WE
中科院分区：
文献类型：
--
作者：
McMillan SC;Small BJ;Haley WE
系统评估对于姑息治疗至关重要，但确认临终关怀机构完成系统评估的文件往往不充分或缺乏。与通常的临床实践相比，确定来自临终关怀患者/护理人员二人的标准化评估工具的系统反馈在改善临终关怀结果方面的功效。新入住两家临终关怀家庭护理机构的患者样本 (n=709) 都有指定的家庭护理人员。照顾这些二人组的跨学科团队 (IDT) 被随机分配到实验条件 (n=338) 或控制条件 (n=371)。在入院时以及讨论这些二人组的前两次 IDT 会议各一周后，使用标准化评估从两组二人组中收集数据。实验干预包括向 IDT 报告标准化评估的数据。结果显示，干预措施改善了患者抑郁症 (p.<.001)，并且两组患者的生活质量均得到改善 (p.<.001)。其他患者结果（症状困扰、精神需求）或护理人员结果（抑郁、支持、精神需求）没有显着差异。在常规护理中添加抑郁症评估可能会产生效果，因为它通常不是临终关怀工作人员关注的焦点。研究期间临终关怀非常好，标准护理使整体生活质量得到改善，而其他变量的改善空间很小。临终关怀患者需要对抑郁症进行系统评估。照顾者变量没有变化，这可能表明需要关注照顾者。
Systematic assessment is vital to palliative care, but documentation confirming completion of systematic assessment in hospice settings is often inadequate or absent. To determine the efficacy of systematic feedback from standardized assessment tools for hospice patient/caregiver dyads in improving hospice outcomes compared to the usual clinical practice. The sample of patients (n=709) newly admitted to hospice homecare in two hospices had designated family caregivers. The interdisciplinary teams (IDT) caring for these dyads were randomly assigned to either experimental (n=338) or control (n=371) conditions. Data were collected from both groups of dyads using standardized assessments on admission, and one week after each of the first two IDT meetings in which these dyads were discussed. The experimental intervention consisted of reporting data from the standardized assessments to the IDTs. Results showed improved patient depression (p.<.001) as a result of the intervention, and improvement in both groups in patient quality of life (p.<.001). No other patient outcomes (symptom distress, spiritual needs) or caregiver outcomes (depression, support, spiritual needs) were significantly different. Assessment of depression added to usual care probably had an effect because it is not normally a focus of hospice staff. Hospice care was so good during the study that overall quality of life improved as a result of standard care and left little room for improvement in other variables. Systematic assessment of depression is needed in hospice patients. No caregiver variables changed, which may indicate a need for a focus on caregivers.