Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial.
Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial.
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DOI：
10.1001/jama.2009.1198
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发表时间：
2009-08-19
影响因子：
120.7
通讯作者：
Ahles, Tim A.
中科院分区：
文献类型：
--
作者：
Bakitas, Marie;Lyons, Kathleen Doyle;Hegel, Mark T.;Balan, Stefan;Brokaw, Frances C.;Seville, Janette;Hull, Jay G.;Li, Zhongze;Tosteson, Tor D.;Byock, Ira R.;Ahles, Tim A.
很少有随机对照试验的有效性姑息治疗。确定姑息治疗干预对生活质量（QOL）、症状强度、情绪和资源利用的影响。随机对照试验（2003年11月至2008年5月），纳入322例晚期癌症患者和一名确定的护理人员，这些患者来自一家乡村、NCI指定的综合癌症中心（诺里斯棉花癌症中心，黎巴嫩，NH）及其附属外展诊所和退伍军人事务医疗中心（白河交汇处，VT）。由高级执业护士进行的多成分、心理教育、姑息治疗干预（Project ENABLE），包括每周4次教育课程和每月随访，直至死亡或研究完成。(1)慢性病姑息治疗的功能评估（范围：0 - 184;评分越高表示QOL越好），（2）埃德蒙顿症状评估量表（范围：0至900;分数越高表示症状强度越大），（3）流行病学中心抑郁症（范围：0至60;分数越高表示抑郁症状越多），在基线、1个月和每3个月完成，直至死亡或研究完成，（4）住院、重症监护室（ICU），和急诊室就诊记录在病历中。322名患有胃肠癌（41%）、肺癌（36%）、泌尿生殖系统癌（12%）和乳腺癌（10%）的参与者被随机分组。所有受试者的估计治疗效果（干预减去常规护理）为QOL 4.6（P = .02），症状强度-27.8（P = .06），抑郁情绪-1.8（P = .02）。在研究期间死亡的参与者样本中，QOL的估计平均治疗效果为8.6（P = .02），症状强度为-24.2（P = .24），抑郁情绪为-2.7（P = .03）。住院天数、重症监护室和急诊科就诊在两组之间没有差异。与接受常规肿瘤治疗的受试者相比，接受姑息治疗干预的受试者在接受肿瘤治疗的同时接受身体、心理和护理协调，其生活质量和情绪更高;症状强度和住院天数、ICU和急诊室就诊的比较无统计学意义。clinicaltrials.gov标识符：NCT 00253383
There are few randomized controlled trials of the effectiveness of palliative care. To determine the effect of a palliative care intervention on quality of life (QOL), symptom intensity, mood, and resource utilization. Randomized controlled trial (November 2003-May 2008) of 322 patients with advanced cancer and an identified caregiver in a rural, NCI-designated comprehensive cancer center (the Norris Cotton Cancer Center, Lebanon, NH) and affiliated outreach clinics and Veteran’s Affairs Medical Center (White River Junction, VT). A multi-component, psycho-educational, palliative care intervention (Project ENABLE) conducted by an advanced practice nurse consisting of 4 weekly educational sessions and monthly follow-up until death or study completion. (1) The Functional Assessment of Chronic Illness Therapy-Palliative (range: 0 to 184; higher scores indicate better QOL), (2) Edmonton Symptom Assessment Scale (range: 0 to 900; higher scores indicate greater symptom intensity), (3) Center for Epidemiological Studies-Depression (range: 0 to 60; higher scores indicate more depressive symptoms), completed at baseline, 1 month and every 3 months until death or study completion, (4) days in hospital, intensive care unit (ICU), and emergency department visits recorded in the medical record. 322 participants with gastrointestinal (41%), lung (36%), genitourinary (12%), and breast (10%) cancer were randomized. Estimated treatment effects (intervention minus usual care) for all subjects were 4.6 (P = .02) for QOL, −27.8 (P = .06) for symptom intensity, and −1.8 (P = .02) for depressed mood. Estimated average treatment effects in the sample of participants who died during the study were 8.6 (P = .02) for QOL, −24.2 (P = .24) for symptom intensity, and −2.7 (P = .03) for depressed mood. Days in hospital, intensive care unit, and emergency department visits were not different between groups. Compared to participants receiving usual oncology care, participants receiving a palliative care intervention addressing physical, psychosocial, and care coordination provided concurrently with oncology care had higher QOL and mood; comparisons of symptom intensity and days in hospital, ICU, and emergency department visits were not statistically significant. clinicaltrials.gov Identifier: NCT00253383
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影响因子：
2.2
作者：
Bakitas M;Lyons KD;Hegel MT;Balan S;Barnett KN;Brokaw FC;Byock IR;Hull JG;Li Z;McKinstry E;Seville JL;Ahles TA
通讯作者：
Ahles TA
影响因子：
45.3
作者：
Earle, Craig C.;Landrum, Mary Beth;Ayanian, John Z.
通讯作者：
Ayanian, John Z.
影响因子：
4.4
作者：
Bee PE;Bower P;Lovell K;Gilbody S;Richards D;Gask L;Roach P
通讯作者：
Roach P
影响因子：
6.2
作者：
Bakitas, Marie;Ahles, Tim A.;Hegel, Mark T.
通讯作者：
Hegel, Mark T.
影响因子：
4.7
作者：
Ahles, TA;Seville, J;Stukel, TA
通讯作者：
Stukel, TA