The long term impact of an end-of-life communication intervention among veterans with COPD.
The long term impact of an end-of-life communication intervention among veterans with COPD.
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DOI：
10.1016/j.hrtlng.2016.10.003
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发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Au DH
中科院分区：
文献类型：
--
作者：
Reinke LF;Feemster LC;McDowell J;Gunnink E;Tartaglione EV;Udris E;Curtis JR;Au DH
本研究的目的是评估对慢性阻塞性肺病患者的临终沟通干预是否可以提高临终时预先护理计划讨论的长期记录。我们之前证明，向临床医生提供一份简短的患者特定反馈表，了解患者对临终沟通的偏好，可以改善临床医生关于临终护理的沟通的发生和质量。该研究是在普吉特湾退伍军人管理局医疗系统进行的。在那些参加干预研究（2004-2007）并在随访期间（截至 2013 年）死亡的个体中，我们评估了干预组的患者与对照组的患者相比是否有更多的护理讨论目标和完成的正式预先指示。我们建立了逻辑模型来解释提供商级别的聚类，并根据年龄、FEV1 和种族进行调整。在母研究的 376 名患者中，有 157 人死亡，其中干预组 76 人，对照组 81 人。平均年龄为 72.5 岁 (SD 9.1)，99% 为男性，平均 FEV1% 预测为 45 (SD 17.8)。在平均 3.6 年的时间里（从第一次研究预约到死亡），115 名患者 (73%) 参与了 451 次独特的临终关怀讨论。干预与记录临终谈话的患者比例较高（I:C 75% vs 72%，p=0.63）或完成预先护理指示（26% vs 29%，p=0.55）无关。尽管最初改善了临终对话的发生率，但干预措施并没有增加有关临终关怀的后续对话的记录，也没有改善预先指示的记录。我们队列中 75% 的患者记录了后续对话，显示大多数患者都进行了这些对话，但仍有改进的空间，并且对目标一致护理的影响尚不清楚。未来的研究应侧重于测试多方面、纵向、系统级干预措施，以加强有关促进目标并行护理的护理目标的对话。
The purpose of this study was to assess if an end-of-life communication intervention with patients with COPD led to higher long-term documentation of advance care planning discussions at the end-of-life. We previously demonstrated that providing clinicians a brief patient-specific feedback form about patients’ preferences for end-of-life communication improved the occurrence and quality of clinician communication about end-of-life care. The study was conducted at the Puget Sound VA Healthcare System. Among those individuals enrolled in the intervention study (2004–2007) who had died during the follow-up period (up to 2013), we assessed if patients in the intervention arm had more goals of care discussions and formal advance directives completed as compared to patients in the control arm. We conducted logistic models accounting for provider level clustering, adjusting for age, FEV1, and race. Among the 376 patients in the parent study, 157 died, of which 76 were in the intervention arm and 81 in the control arm. The mean age was 72.5 (SD 9.1), 99% were male, with a mean FEV1% predicted of 45 (SD 17.8). Over an average duration of 3.6 years (from the time of the first study appointment to death), 115 (73%) patients engaged in 451 unique end-of-life care discussions. The intervention was not associated with a higher percentage of patients with documented end-of-life conversations (I:C 75% vs 72%, p=0.63) or completion of advance care directives (26% vs 29%, p=0.55). Despite initially improving the occurrence of end-of-life conversations, the intervention did not increase the documentation of subsequent conversations about end-of-life care, nor did it improve documentation of advance directives. Seventy-five percent of the patients in our cohort had documented follow-up conversations showing most have these conversations, but there is room for improvement and an unclear impact on goal-concordant care. Future research should focus on testing multi-faceted, longitudinal, system-level interventions to enhance conversations about goals of care that promote goal-concurrent care.
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影响因子：
120.7
作者：
Curtis, J. Randall;Back, Anthony L.;Engelberg, Ruth A.
通讯作者：
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影响因子：
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作者：
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DOI：
10.1164/rccm.201508-1628cp
发表时间：
2016-02-01
影响因子：
24.7
作者：
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通讯作者：
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作者：
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特定疾病的预科护理计划干预对临终护理的影响。
影响因子：
6.3
作者：
Kirchhoff KT;Hammes BJ;Kehl KA;Briggs LA;Brown RL
通讯作者：
Brown RL