Operationalizing needs-focused palliative care for older adults in intensive care units: Design of and rationale for the PCplanner randomized clinical trial.
Operationalizing needs-focused palliative care for older adults in intensive care units: Design of and rationale for the PCplanner randomized clinical trial.
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DOI：
10.1016/j.cct.2020.106163
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发表时间：
2020-11
影响因子：
2.2
通讯作者：
Docherty SL
中科院分区：
文献类型：
--
作者：
Cox CE;Olsen MK;Casarett D;Haines K;Al-Hegelan M;Bartz RR;Katz JN;Naglee C;Ashana D;Gilstrap D;Gu J;Parish A;Frear A;Krishnamaneni D;Corcoran A;Docherty SL
在重症监护室（ICU）接受生命支持的老年人数量目前每年有200万人，正在增加，而生存率保持不变。由于基于ICU的姑息治疗的质量差异很大，我们开发了一种移动的应用程序干预，该应用程序集成到电子健康记录（EHR）系统中，称为PCplanner（姑息治疗计划器），旨在改善ICU环境中的协作初级和专科姑息治疗交付。描述正在进行的比较PCplanner与常规护理的随机临床试验（RCT）的方法。该双组、平行组混合方法RCT的目标是确定PCplanner干预对患者、家庭成员、临床医生和政策制定者在3个月随访期内关注的结局的临床影响。主要结局是基线和随机化后1周之间通过NEST工具测量的未满足姑息治疗需求的变化。次要结局包括随机化后1周的护理目标一致性、以患者为中心的护理和沟通质量;住院时间;以及随机化后3个月的抑郁、焦虑和创伤后应激障碍症状。我们将使用一般线性模型进行重复测量，以比较主效应和因素相互作用的结果。我们假设，与常规护理相比，PCplanner将对核心姑息治疗需求、心理困扰、以患者为中心和医疗资源利用等领域的ICU姑息治疗质量产生更大影响。
The number of older adults who receive life support in an intensive care unit (ICU), now 2 million per year, is increasing while survival remains unchanged. Because the quality of ICU-based palliative care is highly variable, we developed a mobile app intervention that integrates into the electronic health records (EHR) system called PCplanner (Palliative Care planner) with the goal of improving collaborative primary and specialist palliative care delivery in ICU settings. To describe the methods of a randomized clinical trial (RCT) being conducted to compare PCplanner vs. usual care. The goal of this two-arm, parallel group mixed methods RCT is to determine the clinical impact of the PCplanner intervention on outcomes of interest to patients, family members, clinicians, and policymakers over a 3-month follow up period. The primary outcome is change in unmet palliative care needs measured by the NEST instrument between baseline and 1 week post-randomization. Secondary outcomes include goal concordance of care, patient-centeredness of care, and quality of communication at 1 week post-randomization; length of stay; as well as symptoms of depression, anxiety, and post-traumatic stress disorder at 3 months post-randomization. We will use general linear models for repeated measures to compare outcomes across the main effects and interactions of the factors. We hypothesize that compared to usual care, PCplanner will have a greater impact on the quality of ICU-based palliative care delivery across domains of core palliative care needs, psychological distress, patient-centeredness, and healthcare resource utilization.
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
120.7
作者：
Curtis, J. Randall;Back, Anthony L.;Engelberg, Ruth A.
通讯作者：
Engelberg, Ruth A.
DOI：
10.1164/rccm.201508-1628cp
发表时间：
2016-02-01
影响因子：
24.7
作者：
Cox, Christopher E.;Curtis, J. Randall
通讯作者：
Curtis, J. Randall
影响因子：
2.8
作者：
Aslakson, Rebecca A.;Reinke, Lynn F.;Curtis, J. Randall
通讯作者：
Curtis, J. Randall
影响因子：
8.3
作者：
Baldwin, Matthew R;Wunsch, Hannah;Bach, Peter
通讯作者：
Bach, Peter