Rationale and design of technology assisted stepped collaborative care intervention to improve patient-centered outcomes in hemodialysis patients (TĀCcare trial).
Rationale and design of technology assisted stepped collaborative care intervention to improve patient-centered outcomes in hemodialysis patients (TĀCcare trial).
复制标题
技术的基本原理和设计辅助分步协作护理干预，以改善血液透析患者以患者为中心的结果（TäCcare 试验）。
DOI：
10.1016/j.cct.2018.09.002
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发表时间：
2018
影响因子：
2.2
通讯作者：
Jhamb,Manisha
中科院分区：
文献类型：
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作者：
Roumelioti,Maria-Eleni;Steel,JenniferL;Yabes,Jonathan;Vowles,KevinE;Vodovotz,Yoram;Beach,Scott;Rollman,Bruce;Weisbord,StevenD;Unruh,MarkL;Jhamb,Manisha
大多数血液透析（HD）患者会出现抑郁、疼痛和疲劳症状，这些症状严重影响了他们的健康相关生活质量（HRQOL）。这些症状与住院和死亡率增加相关，由行为因素（例如不依从药物和透析）和生物因素（例如炎性细胞因子）介导。既往缓解症状和改善HRQOL的干预措施在HD患者中的有效性有限，并且缺乏对生物行为介质的影响的证据。必须改善以患者为中心的透析护理，并响应肾脏疾病改善全球结局（KDIGO）指南中关于在常规HD护理中整合症状评估和管理的呼吁。技术辅助的阶梯式协作护理（TSCCcare）是一项在宾夕法尼亚州和新墨西哥州的150例不同HD患者中开展的多中心随机对照试验（RCT），旨在比较为期12周的阶梯式协作护理干预（认知行为疗法，CBT）与技术提供的健康教育的注意力控制臂的有效性。协作护理提供了一个综合的多学科结构化管理计划。此外，药物治疗和/或CBT的阶梯式方法允许根据患者的临床状态，偏好和治疗反应进行个性化治疗。为了简化CBT的交付并最大限度地减少患者和提供者的负担，我们将与透析单位的患者进行实时视频会议。我们将研究这些干预措施对患者症状、HRQOL、治疗依从性和炎症生物标志物的影响。这项随机对照试验测试了一种易于实施的干预措施，可以整合到常规HD护理中，并将对缓解HD常见症状和改善HRQOL的策略产生新的有意义的见解。
Most hemodialysis (HD) patients experience symptoms of depression, pain and fatigue that impair their health-related quality of life (HRQOL) significantly. These symptoms are associated with increased hospitalization and mortality, mediated by behavioral factors (e.g. non-adherence to medication and dialysis) and biological factors (e.g. inflammatory cytokines). Prior interventions to alleviate symptoms and improve HRQOL showed limited effectiveness in HD patients and their effect on bio-behavioral mediators is lacking evidence. It is imperative to improve patient-centered dialysis care and to address call from Kidney Disease Improving Global Outcomes (KDIGO) guidelines for integration of symptom assessment and management in routine HD-care. Technology-Assisted stepped Collaborative Care (TĀCcare) is a multi-center randomized controlled trial (RCT) of 150 diverse HD patients from Pennsylvania and New Mexico, designed to compare the effectiveness of a 12-week stepped collaborative care intervention (cognitive behavioral therapy, CBT) with an attention control arm of technology-delivered health education. Collaborative care provides an integrated multi-disciplinary structured management plan. Furthermore, a stepped approach to pharmacotherapy and/or CBT allows for individualization of treatment according to patients' clinical status, preferences and treatment response. To simplify the delivery of CBT and to minimize patient and provider burden, we will use live video-conferencing with patients in dialysis units. We will examine the effect of these interventions on patient symptoms, HRQOL, treatment adherence and inflammatory biomarkers. This RCT tests a readily implementable intervention that can be integrated in routine HD-care and will generate novel and meaningful insights on strategies to alleviate common symptoms and improve HRQOL in HD.