Assessing and Treating Symptoms of Dying ICU Patients

描述（由申请人提供）：本前瞻性、描述性研究的目的是探讨重症监护病房（ICU）高危死亡患者的症状经历和这些症状的药物治疗。本研究的具体目的是检查ICU高危死亡患者及其家属、ICU护士和医生的观点，以便：(1)确定患者在ICU期间的症状特征（即患病率、强度、频率和痛苦）；(2)确定患者、家属、护士和医生对患者症状特征的一致程度；(3)研究某些因素（如年龄、性别、种族、疾病急性程度、护患人员比例、医院地点和“不抢救”状态）与症状特征的关系；(4)评估某些症状（如疼痛、焦虑、呼吸短促、烦躁不安和精神错乱）的药理学症状管理方法。研究样本为250名英语、西班牙语和中文的高危ICU患者及其家属、ICU护士和ICU医生作为代理举证人。患者和举报人将在患者ICU住院的7天内使用10项症状清单对患者的症状特征进行评分。人口统计、用药和诊断数据将通过患者病历审查获得。将根据APACHE II计算患者的疾病敏锐度，并记录护士-患者人员配置比例、医院地点和患者的不抢救状态。混合效应模型将用于分析患者在ICU的不同时间的症状特征，并根据不同的信息者群体对症状特征进行比较。混合效应模型将检验潜在的解释变量（年龄、性别、种族、疾病急性程度、护士-病人人员比例、医院地点和不抢救状态）和病人症状特征之间的关联。回归分析将用于检查特定因素对药物症状管理实践的影响。

DESCRIPTION (provided by applicant): The purpose of this prospective, descriptive study is to examine the symptom experiences of Intensive Care Unit (ICU) patients at high risk of dying and the pharmacologic management of those symptoms. The study's specific aims are to examine the perspectives of ICU patients at high risk of dying as well as family members, ICU nurses, and physicians in order to: (1) determine patient symptom characteristics (i.e., prevalence, intensity, frequency, and distress) across time in ICU; (2) determine level of agreement regarding patient symptom characteristics among patients, family members, nurses, and physicians; (3) examine the association of certain factors [e.g., age, gender, ethnicity, illness acuity, nurse-patient staffing ratios, hospital site, and "do-not-resuscitate" (DNR) status] with symptom characteristics; (4) evaluate pharmacologic symptom management practices for certain symptoms (e.g., pain, anxiety, shortness of breath, restlessness, and confusion). The study sample will be 250 English-, Spanish-, and Chinese-speaking ICU patients at high risk of dying as well as their family members, ICU nurses, and ICU physicians who will be proxy informants. Patients and informants will rate patient symptom characteristics using a 10-item symptom checklist on seven days of the patient's ICU stay. Demographic, medication, and diagnostic data will be obtained through patient chart reviews. Patient illness acuity levels will be calculated per APACHE II, and nurse-patient staffing ratios, hospital site, and patient's DNR status will be recorded. Mixed-effects models will be used to analyze patient symptom characteristics across time in ICU and to make comparisons of symptom characteristics according to the different groups of informants. The mixed effects models will examine associations among potential explanatory variables (age, gender, ethnicity, illness acuity, nurse-patient staffing ratios, hospital site, and DNR status) and patient symptom characteristics. Regression analyses will be used to examine the influence of specific factors on pharmacologic symptom management practices. The study will provide a unique and comprehensive understanding of symptoms experienced by patients at high risk of dying in ICUs. Results will also contribute empirical data needed to generate and test hypotheses concerning appropriate symptom assessment and management interventions.