Improving Palliative Care for Patients with Cancer

描述：(由申请人提供)医学研究所最近的报告得出结论，迫切需要进行旨在改善生命末期护理的研究。项目Enable是Robert Wood Johnson资助的一个旨在改善癌症患者临终关怀的示范项目，该项目表明，专注于早期干预(在晚期癌症确诊时)、患者教育、基于偏好的治疗和协调护理的姑息关怀模式：1)在综合癌症中心实施是可行的；2)被专注于积极/临床试验导向的护理的肿瘤学家接受；以及3)患者和家庭成员接受和重视。该应用程序旨在通过整合达特茅斯北部新英格兰合作研究小组开发的方法来改进Enable干预并提高其效率，这些方法侧重于实践系统的变化，以提高护理的质量和效率。该应用程序的主要目标是测试改善癌症患者姑息治疗干预措施的有效性，其中包括：1)达特茅斯临床改进系统，强调对问题的快速评估并向患者(包括定制的教育材料)和从业者提供反馈；2)电话护士教育人员，将提供持续的症状和问题评估、癌症中心医疗团队与其他服务之间的协调护理，以及有关解决问题、与医疗团队的沟通、高级护理计划和症状管理的教育；以及3)针对症状管理的临时团体医疗预约(DIGMA)。在诺里斯·科顿癌症中心就诊的晚期肺癌、胃肠道癌和乳腺癌患者将在确诊时被识别出来，并随机接受Enable II干预或标准护理。基本假设是：1)与标准护理组的患者相比，随机接受Enable II干预的患者将报告更好的症状管理、更高的生活质量、偏好与所接受护理之间的更好匹配、以及更低的卫生保健利用率；2)接受Enable II干预的患者的家庭成员将报告更好的护理质量、症状管理以及通过死后访谈测量的偏好与所接受护理之间的匹配。

DESCRIPTION: (Provided by applicant) The recent report of the Institute of Medicine concludes that there is a critical need for research designed to improve care at the end of life. Project ENABLE, a Robert Wood Johnson funded demonstration project designed to improve end-of-life care in cancer patients, showed that a palliative care model that focused on early intervention (at the time of diagnosis of advanced cancer), patient education, preference- based treatment and coordinated care is: 1) feasible to implement in a comprehensive cancer center; 2) accepted by oncologists who are focused on aggressive/clinical trials- oriented care; and 3) accepted and valued by patients and family members. This application is designed to refine the ENABLE intervention and increase its efficiency by integrating approaches developed by the Dartmouth Northern New England Cooperative Research Group that have focused on practice system changes that improve quality and efficiency of care. The primary goal of this application is to test the efficacy of an intervention for improving palliative care for cancer patients that includes: 1) the Dartmouth Clinical Improvement System which emphasizes rapid assessment of problems and feedback to patients (including tailored educational materials) and practitioners; 2) telephone- base nurse educators who will provide ongoing symptom and problem assessment, coordination of care between the cancer center health care team and other services, and education regarding problem-solving, communication with the healthcare team, advanced care planning and symptom management; and 3) Drop-In Group Medical Appointments (DIGMAs) for symptom management. Patients with advanced lung, gastrointestinal, and breast cancer seen at the Norris Cotton Cancer Center will be identified at diagnosis and randomized to receive the ENABLE II intervention or standard care. The primary hypotheses are: 1) Patients randomized to the ENABLE II intervention will report better symptom management, higher quality of life, a better match between preferences and the care received, and lower health care utilization as compared to patients in the standard care group and 2) Family members of patients receiving the ENABLE II intervention will report better quality of care, symptom management, and match between preferences and care received as measured by the After Death Interview.