Systematic Assessment to Improve Hospice Outcomes

改善临终关怀结果的系统评估

• 批准号: 6773628
• 负责人: SUSAN C MCMILLAN
• 金额: $ 46.81万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6773628
• 关键词: adult human (21+); bereavement; caregivers; clinical research; depression; diagnosis design /evaluation; diagnostic tests; health care service evaluation; health services research tag; home health care; hospices; human subject; interdisciplinary collaboration; longitudinal human study; neoplasm /cancer; nursing research; outcomes research; patient care management; patient oriented research; psychological adaptation; psychometrics; quality of life; religion; sign /symptom; social service; terminal patient care

DESCRIPTION (provided by applicant): Complete, accurate, and systematic assessment is known to be essential for providing effective care in any setting. However, research reveals that this assessment is frequently missing from patient records, leading to care that are less than ideal. This need for careful assessment is no less necessary in hospice homecare. Growing numbers of patients are receiving hospice care each year; thus, improving assessment in this setting has the potential for improving care to thousands of patients each day. The primary aims of this study are to determine the efficacy of providing systematic feedback from standardized assessment tools for hospice patients and caregivers in improving hospice outcomes compared to usual practice, and in addition, using those standardized assessments, to identify symptom clusters in hospice patients and how they impact on patient and caregiver well-being. Patient outcomes to be measured include symptom intensity and distress, quality of life, depression, and spiritual well-being. Caregiver outcomes being measured include depression, spiritual well-being during active care, and depression 3 and 12 months after the death. The sample of 306 patient/caregiver dyads will be drawn from three large hospices that are partners in the Center for Hospice, Palliative Care and End of Life Studies at the University of South Florida. Patients must have cancer, and will be screened using the Short Portable Mental Status Questionnaire and the Palliative Performance Scale. In each hospice, two interdisciplinary care teams will be identified that provide homecare to equivalent groups of patients; one will be randomized as the control team and one the experimental team. Patients and caregivers on all teams will be admitted to the study 24-72 hours after admission to hospice and will complete all assessments. For the experimental teams, the RN's and social workers who are collecting the data will attend the weekly interdisciplinary team meetings and report the data they have collected during the previous week. Data collection and reporting will occur at baseline and then weekly for two weeks at which time the patients will be finished with the study. In order to monitor care changes that result from the enhanced assessments, charts will be audited to compare the numbers of home visits and medication and other careplan changes between the experimental and control groups. Caregivers will be visited again at 3 and 12 months after the death to evaluate whether the improved care provided to patients on the experimental teams resulted in significantly less depressive symptoms. Patient/caregiver dyads will be accrued for 30 months with an additional 12 months of follow-up data collection for depression data. Quantitative data will be analyzed using mixed models analysis, repeated measures multivariate analysis of variance, discriminant function analysis and cluster analysis.

描述（由申请人提供）：已知完整、准确和系统的评估对于在任何环境中提供有效护理至关重要。然而，研究表明，这种评估经常从患者记录中缺失，导致护理不太理想。这种仔细评估的必要性在临终关怀家庭护理中也同样必要。越来越多的病人每年接受临终关怀，因此，在这种情况下，改善评估有可能改善护理成千上万的病人每天。本研究的主要目的是确定从标准化评估工具为临终关怀患者和护理人员提供系统反馈的有效性，与常规做法相比，改善临终关怀结果，此外，使用这些标准化评估，以确定临终关怀患者的症状群以及它们如何影响患者和护理人员的福祉。要测量的患者结果包括症状强度和痛苦、生活质量、抑郁和精神健康。正在测量的护理结果包括抑郁症，积极护理期间的精神健康，以及死亡后3个月和12个月的抑郁症。306名患者/护理人员的样本将从南佛罗里达大学临终关怀、姑息治疗和生命终结研究中心的三家大型临终关怀机构中抽取。患者必须患有癌症，并将使用简易精神状态问卷和姑息性行为量表进行筛选。在每个临终关怀中心，将确定两个跨学科护理团队，为同等患者群体提供家庭护理;一个将被随机分配为对照组，另一个为实验组。所有团队的患者和护理人员将在入住临终关怀医院后24-72小时进入研究，并完成所有评估。对于实验团队，正在收集数据的RN和社会工作者将参加每周的跨学科团队会议，并报告他们在前一周收集的数据。数据收集和报告将在基线时进行，然后每周进行一次，持续两周，届时患者将完成研究。为了监测增强评估导致的护理变化，将对图表进行审核，以比较实验组和对照组之间的家访次数、药物和其他护理计划变化。死亡后3个月和12个月将再次拜访护理人员，以评估实验团队为患者提供的改善护理是否显着减少了抑郁症状。患者/护理人员配对将累积30个月，并额外收集12个月的抑郁数据随访数据。定量数据将使用混合模型分析、重复测量多变量方差分析、判别函数分析和聚类分析进行分析。