Palliative Care for Persons with Late-stage Alzheimer's and Related Dementias and their Caregivers: a Randomized Clinical Trial
对晚期阿尔茨海默病和相关痴呆症患者及其护理人员的姑息治疗:一项随机临床试验
基本信息
- 批准号:10461880
- 负责人:
- 金额:$ 87.33万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2020
- 资助国家:美国
- 起止时间:2020-09-10 至 2025-05-31
- 项目状态:未结题
- 来源:
- 关键词:AcuteAddressAdvance DirectivesAffectAlzheimer&aposs DiseaseAlzheimer&aposs disease related dementiaAmericanAwarenessCaregiversCaringColoradoCommunicationCommunitiesDecision MakingDehydrationDementiaDementia caregiversDependenceDistressEducationEducational MaterialsElderlyEmergency department visitEmotionalEnrollmentEquipment and supply inventoriesFamilyFamily CaregiverFinancial HardshipGeneral HospitalsGeographyGoalsHealth care facilityHealthcareHomeHospitalizationHospitalsIndianaInfectionInterventionLearningLength of StayMassachusettsNomadsNorth CarolinaNursing HomesOutcomePalliative CarePalliative Care NursingPatient-Focused OutcomesPatientsPersonsPrognosisQuality of CareQuality of lifeQuestionnairesRandomizedRandomized Clinical TrialsRapid screeningReportingResearchScienceSelf PerceptionServicesSiteStandardizationSymptomsSystemTestingUniversitiesadvanced dementiaarmbasecaregiver educationcaregiver straincase findingcomorbiditycostdementia caregivingdesignend of lifeexperiencefall injuryhospice environmentimprovedimproved outcomeindexingmemberneuropsychiatric symptomneuropsychiatrynovelpalliativepatient orientedphysical symptomprimary outcomeprognosticprogramssecondary outcomeshared decision makingsymptom managementsymptom treatmentsymptomatic improvementtreatment arm
项目摘要
ABSTRACT
Alzheimer’s disease and related dementias (ADRD) affect 5.6 million Americans at an annual cost of $157
billion. Three million Americans have late-stage ADRD with suffering caused by progressive dependency and
distressing symptoms. Family caregivers experience extraordinary physical, emotional and financial strain.
Hospitalizations for acute illnesses are common in late-stage ADRD, with worsened symptoms and
distressing decisions about goals of care and intensive treatments. Hospitalizations also present a unique
opportunity for dementia-specific palliative care to address suffering and reduce burdensome treatments, since
72% of hospitals have palliative care teams. Palliative care improves symptom control and quality of life in
serious illnesses, but has never been adapted and tested for the unique needs of late-stage ADRD.
We therefore developed the ADRD Palliative Care (ADRD-PC) program. Using a novel rapid screening
system, we randomized 62 dyads of hospitalized patients with late-stage ADRD and their family caregivers to
the ADRD-PC program vs education control. Intervention dyads received i) dementia-specific palliative care, ii)
standardized caregiver education, and iii) transitional care delivered by an interdisciplinary palliative care team;
control dyads received educational material on dementia caregiving. The ADRD-PC program was well-
accepted, and resulted in significant improvements in use of hospice, symptom management, caregiver
communication about prognosis and goals of care, new advance directives, and “Do Not Hospitalize” orders.
The necessary next step to advance the science of dementia-specific palliative care is an adequately powered
RCT of the efficacy of the ADRD-PC program to improve patient and family centered outcomes.
Our research objective is to conduct a multi-site efficacy RCT of the ADRD-PC program. We will enroll
424 dyads of hospitalized patients with late-stage ADRD and family caregivers at 4 geographically diverse
member sites of the Palliative Care Research Cooperative group. Our Specific Aims are:
Aim 1: To conduct a multi-site RCT of the ADRD-PC program of dementia-specific palliative and transitional
care (intervention arm) vs publicly available educational material for dementia caregivers (control arm) to
compare 60-day hospital transfers (hospitalization and emergency room visits) for persons with late-stage
ADRD (primary outcome).
Aim 2: To compare patient-centered secondary outcomes between intervention and control arms: a) symptom
treatment; b) symptom control; c) post-acute use of community palliative care or hospice; and d) new nursing
home transitions.
Aim 3: To compare caregiver-centered secondary outcomes between intervention and control arms: a)
communication about prognosis and goals of care; b) shared decision-making; and c) caregiver distress.
IMPACT: ADRD-PC has the potential to reduce suffering for millions of persons with late-stage ADRD.
摘要
项目成果
期刊论文数量(0)
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LAURA C HANSON其他文献
LAURA C HANSON的其他文献
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{{ truncateString('LAURA C HANSON', 18)}}的其他基金
Palliative Care for Persons with Late-stage Alzheimer's and Related Dementias and their Caregivers a Randomized Clinical Trial
晚期阿尔茨海默病和相关痴呆症患者及其护理人员的姑息治疗随机临床试验
- 批准号:
10631651 - 财政年份:2020
- 资助金额:
$ 87.33万 - 项目类别:
Palliative Care for Persons with Late-stage Alzheimer's and Related Dementias and their Caregivers: a Randomized Clinical Trial
对晚期阿尔茨海默病和相关痴呆症患者及其护理人员的姑息治疗:一项随机临床试验
- 批准号:
10259679 - 财政年份:2020
- 资助金额:
$ 87.33万 - 项目类别:
Triggered Palliative Care for Advanced Dementia: A Pilot Study
引发晚期痴呆症的姑息治疗:一项试点研究
- 批准号:
9016103 - 财政年份:2016
- 资助金额:
$ 87.33万 - 项目类别:
Palliative Care Research Cooperative Group (PCRC): Measurement Core
姑息治疗研究合作小组 (PCRC):测量核心
- 批准号:
10207783 - 财政年份:2013
- 资助金额:
$ 87.33万 - 项目类别:
Palliative Care Research Cooperative Group (PCRC): Measurement Core
姑息治疗研究合作小组 (PCRC):测量核心
- 批准号:
10438798 - 财政年份:2013
- 资助金额:
$ 87.33万 - 项目类别:
Goals of Care: A Nursing Home Trial of Decision Support for Advanced Dementia
护理目标:针对晚期痴呆症的决策支持的疗养院试验
- 批准号:
8103590 - 财政年份:2011
- 资助金额:
$ 87.33万 - 项目类别:
Goals of Care: A Nursing Home Trial of Decision Support for Advanced Dementia
护理目标:针对晚期痴呆症的决策支持的疗养院试验
- 批准号:
8257923 - 财政年份:2011
- 资助金额:
$ 87.33万 - 项目类别:
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