Effects & Costs of Massage in Hospice Cancer Patients

描述（由申请人提供）：超过80%的安宁疗护病人会经历痛苦的症状，这些症状会显著影响他们生命最后几天的舒适度。以前的研究表明，按摩等辅助疗法可以在几分钟到几小时内缓解症状，但没有研究过按摩疗法的累积效果，也没有研究过为临终关怀病人提供按摩的经济有效方法。我们提出了一项随机临床试验（RCT），比较常规护理与常规护理加5次每日按摩治疗，由持照按摩治疗师（LMT）提供的症状结果，包括：a)症状困扰，b)疼痛，c)情绪状态和d)睡眠质量200名不同组的癌症临终关怀患者。在测试前/测试后设计中，在5天的磨合期之前进行重复测量，患者将完成计算机化评估。所有患者将接受一般居家照护水平的安宁疗护，随机分配到实验组的患者将接受为期1周的每日按摩治疗。从第2天到第6天，将汇总每个变量的结果评分，并使用方差分析（MANOVA）进行分析，如果获得显著的组结果，则进行事后比较。研究结果将用于指导安宁疗护提供者选择以证据为基础的补充性干预措施，以减轻临终病人的痛苦症状。第二个目的是确定按摩干预的成本，并比较通常安宁疗护与通常安宁疗护加按摩对安宁疗护报销和利用成本的影响。我们将使用两步作业成本法来确定干预措施的成本和对成本结果的影响。我们假设安宁疗护补偿与使用成本不会有差异，意味著干预将是成本中性的。第三个探索性目的是描述LMT培训60名家庭照顾者每天在家为60名完成aim 1程序的临终关怀病人提供按摩的可行性和照顾者压力。可行性评估将通过：a)护理人员按摩熟练程度；B)护理人员给予的按摩频率和时长；C)护理者和患者对按摩体验的自我报告。压力定义为一周内照顾者压力的变化。我们期望家庭护理人员经过2个疗程的培训、评估和来自LMT的反馈后，能够熟练地提供按摩服务。我们还期望护理人员每天提供3次按摩，每次20至30分钟，并报告他们的护理人员压力没有明显增加。使用Atlas进行描述性统计和内容分析。它将用于评估家庭护理人员提供按摩的可行性，并设计一项临床有效性研究，利用家庭成员作为替代LMTs的成本效益。

DESCRIPTION (provided by applicant): More than 80% of hospice patients experience distressing symptoms that significantly impact comfort in their final days of life. Previous research demonstrated that complimentary therapies such as massage can alleviate symptoms for minutes to hours, but none have examined cumulative effects of massage therapy or cost-effective methods of providing massage to hospice patients. We propose a randomized clinical trial (RCT) comparing usual care versus usual care plus 5 daily massage therapy sessions given by licensed massage therapists (LMT) on symptom outcomes including: a) symptom distress, b) pain, c) mood state and d) sleep quality in a diverse group of 200 hospice patients with cancer. In a pre-test/post-test design with repeated measures preceded by a 5-day run-in period, patients will complete computerized assessments. All patients will receive usual home care level of hospice care, and patients randomized to the experimental group will receive daily massage therapy for 1 week. Outcome scores will be aggregated for each variable from day 2 to day 6 and analyzed using MANOVA, with post-hoc comparisons if significant group results are obtained. Study findings will be used to guide hospice care providers in selecting evidence-based complimentary interventions to relieve distressing symptoms in people at the end of life. A second aim is to determine the costs of the massage intervention and compare the effects of usual hospice care and usual care plus massage on hospice reimbursement and utilization costs. We will use a 2-step activity-based costing methodology for determining the costs of the intervention and the effects on cost outcomes. We hypothesize that the hospice reimbursements and utilization costs will not differ, meaning that the intervention will be cost neutral. A third exploratory aim is to describe the feasibility and the caregiver strain of LMT training 60 family caregivers to give daily massages at home to 60 of the hospice patients who completed Aim 1 procedures. Feasibility will be evaluated by: a) caregiver massage proficiency; b) massage frequency and length given by caregivers; c) caregiver and patient self-report about the massage experience. Strain is defined as the 1-week change in caregiver strain. We expect that family caregivers will be trained to give massages at a proficient level after 2 sessions with training, evaluation and feedback from a LMT. We also expect that caregivers will give 3 daily massages, each for 20 to 30 minutes and report no significant increase in their caregiver strain. Descriptive statistics and content analysis with Atlas.ti will be used to evaluate the feasibility of family caregivers providing massages and to design a clinical effectiveness study using family members as a cost-effective alternative to LMTs.