Effects & Costs of Massage in Hospice Cancer Patients

效果

• 批准号: 7032533
• 负责人: DIANA J WILKIE
• 金额: $ 51.26万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-30 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7032533
• 关键词: caregivers; clinical research; clinical trials; computer human interaction; computer program /software; coping; emotions; health care cost /financing; hospices; human subject; human therapy evaluation; massage therapy; neoplasm /cancer palliative treatment; pain; patient oriented research; sign /symptom; sleep; statistics /biometry; training

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.

描述（由申请人提供）：超过80%的临终关怀患者在生命的最后几天经历了严重影响舒适度的痛苦症状。以前的研究表明，按摩等免费疗法可以缓解症状数分钟至数小时，但没有人检查按摩疗法的累积效应或为临终关怀患者提供按摩的成本效益方法。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个每日按摩治疗疗程的症状结果，包括：a）症状困扰，B）疼痛，c）情绪状态和d）睡眠质量在200例癌症临终关怀患者中。在测试前/测试后设计中，在5天导入期之前进行重复测量，患者将完成计算机化评估。所有患者将接受通常的家庭护理水平的临终关怀，随机分配到实验组的患者将接受每日按摩治疗1周。将汇总第2天至第6天每个变量的结局评分，并使用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临终关怀提供者选择以证据为基础的免费干预措施，以减轻人们在生命结束时的痛苦症状。第二个目的是确定按摩干预的成本，并比较通常的临终关怀和通常的护理加按摩对临终关怀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的成本以及对成本结果的影响。我们假设临终关怀的补偿和利用成本不会有差异，这意味着干预将是成本中性的。第三个探索性的目的是描述的可行性和照顾者应变LMT培训60名家庭照顾者，每天在家里给60名临终关怀患者谁完成了目标1程序。可行性将通过以下方式进行评估：a）护理者按摩熟练程度; B）护理者提供的按摩频率和时长; c）护理者和患者关于按摩体验的自我报告。应变定义为护理人员应变的1周变化。我们希望家庭护理人员在经过2次培训、评估和LMT的反馈后，能够接受熟练按摩的培训。我们还希望护理人员每天进行3次按摩，每次20到30分钟，并且报告他们的护理人员压力没有显著增加。Atlas.ti的描述性统计和内容分析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，使用家庭成员作为LMT的成本效益替代方案。