Palliative care for patients undergoing stem cell transplant: intervention components and supportive care measures.
Palliative care for patients undergoing stem cell transplant: intervention components and supportive care measures.
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DOI：
10.1038/s41409-021-01281-2
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发表时间：
2021-08
影响因子：
4.8
通讯作者：
El-Jawahri A
中科院分区：
文献类型：
--
作者：
Nelson AM;Johnson PC;Kavanaugh AR;Jackson VA;Jagielo AD;Fenech AL;Reynolds MJ;Topping C;Yi AM;Horick N;Temel JS;Greer JA;El-Jawahri A
HCT期间的住院姑息护理干预使患者的生活质量和情绪得到改善。我们试图描述干预的组成部分，调查治疗组在支持性护理实践中的差异，并探索这些差异是否中介了干预对患者生活质量和情绪的影响。我们对一项随机试验进行了二次分析，该试验调查了HCT接受者的住院姑息护理与移植护理相结合与标准移植护理的对比。姑息治疗临床医生完成每周调查，以描述访问期间解决的主题。我们从医疗记录中提取了支持性护理药物的使用情况。参与者在基线和HCT后两周完成了生活质量和情绪评估。因果调解评估支持性护理实践的差异是否中介了干预对患者报告结果的影响。共有160名接受HCT的人参加。姑息治疗访问最常集中于管理症状和应对红细胞压积。随机接受干预的患者更有可能使用患者自控止痛药(32.1%对15.2%，p=0.02)和非典型抗精神病药物(35.8%对17.7%，p=0.01)。PCA和非典型抗精神病药物都不能调节干预对患者报告结果的影响。未来的工作是探索姑息关怀干预改善生活质量和情绪的机制。
An inpatient palliative care intervention during HCT led to improvement in patient QOL and mood. We sought to describe components of the intervention, investigate differences in supportive care practices by treatment arm, and explore whether these differences mediated the impact of the intervention on patient QOL and mood. We conducted a secondary analysis of a randomized trial investigating inpatient palliative care integrated with transplant care versus standard transplant care for HCT recipients. Palliative care clinicians completed weekly surveys to describe topics addressed during visits. We extracted use of supportive care medications from the medical record. Participants completed QOL and mood assessments at baseline and two weeks post-HCT. Causal mediation assessed whether differences in supportive care practices mediated the impact of the intervention on patient-reported outcomes. A total of 160 HCT recipients participated. Palliative care visits most frequently focused on managing symptoms and coping with HCT. Patients randomized to the intervention were more likely to use Patient-Controlled Analgesia (PCA) (32.1% vs. 15.2%, p = 0.02) and atypical antipsychotics (35.8% vs. 17.7%, p = 0.01). Neither PCA nor atypical antipsychotics mediated the effect of the intervention on patient-reported outcomes. Future work to explore mechanisms by which the palliative care intervention improves QOL and mood is needed.
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影响因子：
45.3
作者：
Andrykowski, MAA;Bishop, MM;Wingard, JR
通讯作者：
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影响因子：
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通讯作者：
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影响因子：
4.1
作者：
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