A technology-enhanced model of care for transitional palliative care versus attention control for adult family caregivers in rural or medically underserved areas: study protocol for a randomized controlled trial.
A technology-enhanced model of care for transitional palliative care versus attention control for adult family caregivers in rural or medically underserved areas: study protocol for a randomized controlled trial.
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DOI：
10.1186/s13063-020-04806-0
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发表时间：
2020-10-28
期刊：
影响因子：
2.5
通讯作者：
Griffin JM
中科院分区：
文献类型：
--
作者：
Holland DE;Vanderboom CE;Mandrekar J;Borah BJ;Dose AM;Ingram CJ;Griffin JM
从医院到家庭的过渡护理与不良事件和护理连续性差的风险有关。当新的护理方法，如姑息护理，在出院前引入时，这些转变甚至更具挑战性。家庭照顾者(FCGS)应该在管理护理的同时驾驭这些过渡。除了广泛的护理责任外，FCGS通常还有自己的健康需求，这可能会限制他们提供护理的能力。那些生活在农村地区的人甚至没有更少的资源来满足他们的自我照顾和照顾需求。这项研究的目的是测试一项改善FCGS健康和福祉的干预措施的有效性和成本效益。在医院到家庭的过渡期间，干预使用视频访问来教授、指导和咨询农村地区的FCGS。干预基于过渡性和姑息性护理原则的证据，这些原则是个性化的，以改善护理的连续性，提供照顾者支持，增强知识和技能，并照顾照顾者的健康需求。它的目的是测试通常的护理实践是否类似于这种技术增强的干预在(1)护理技能(例如，护理准备、与临床医生的沟通和对护理的满意度)、(2)FCG健康结果(例如，生活质量、负担、应对技能、抑郁)和(3)成本方面。我们描述了以农村照顾者为目标的理论基础，研究和干预的方法，以及测试干预效果的分析计划。这项研究采用随机对照试验设计，通过计算机生成的列表将FCGS分配给控制条件或照顾者干预。在护理对象出院后，干预期将持续8 周。数据在基线、2 周、8 周和6 月收集。从社会角度来看，时间和金钱成本是按月统计的。这项研究针对两个独立但又相互关联的卫生保健重点-过渡护理和姑息护理-通过测试一种干预措施，以扩大姑息护理实践和改善农村地区重病患者照顾者的过渡管理。综合费用评估将量化FCGS的承诺和财政负担。临床试验.gov NCT03339271。注册日期为2017年11月13日。协议版本：11.补充信息见10.1186/s13063-020-04806-0。
Transitioning care from hospital to home is associated with risks of adverse events and poor continuity of care. These transitions are even more challenging when new approaches to care, such as palliative care, are introduced before discharge. Family caregivers (FCGs) are expected to navigate these transitions while also managing care. In addition to extensive caregiving responsibilities, FCGs often have their own health needs that can inhibit their ability to provide care. Those living in rural areas have even fewer resources to meet their self-care and caregiving needs. The purpose of this study is to test the efficacy and cost-effectiveness of an intervention to improve FCGs’ health and well-being. The intervention uses video visits to teach, guide, and counsel FCGs in rural areas during hospital-to-home transitions. The intervention is based on evidence of transitional and palliative care principles, which are individualized to improve continuity of care, provide caregiver support, enhance knowledge and skills, and attend to caregivers’ health needs. It aims to test whether usual care practices are similar to this technology-enhanced intervention in (1) caregiving skills (e.g., caregiving preparedness, communication with clinicians, and satisfaction with care), (2) FCG health outcomes (e.g., quality of life, burden, coping skills, depression), and (3) cost. We describe the rationale for targeting rural caregivers, the methods for the study and intervention, and the analysis plan to test the intervention’s effect. The study uses a randomized controlled trial design, with FCGs assigned to the control condition or the caregiver intervention by computer-generated lists. The intervention period continues for 8 weeks after care recipients are discharged from the hospital. Data are collected at baseline, 2 weeks, 8 weeks, and 6 months. Time and monetary costs from a societal perspective are captured monthly. This study addresses 2 independent yet interrelated health care foci—transitional care and palliative care—by testing an intervention to extend palliative care practice and improve transition management for caregivers of seriously ill patients in rural areas. The comprehensive cost assessment will quantify the commitment and financial burden of FCGs. ClinicalTrials.gov NCT03339271. Registered on 13 November 2017. Protocol version: 11. Supplementary information accompanies this paper at 10.1186/s13063-020-04806-0.
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