Palliative Care for Cancer Patients in Emergency Wards

急诊室癌症患者的姑息治疗

• 批准号: 7470145
• 负责人: LINDA Leah EMANUEL
• 金额: $ 31.33万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-01 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7470145
• 关键词: Accident and Emergency department; Acute; African American; Attitude; Behavior; Breast; Cancer Patient; Caregivers; Caring; Caucasians; Caucasoid Race; Cessation of life; Chest Pain; Chronic Disease; Clinical; Colon; Communication; Complex; Coupled; Coupling; Crisis Intervention; Diagnosis; Disease; Distress; Doctor of Medicine; Doctor of Philosophy; Dyspnea; Education; Educational Curriculum; Educational process of instructing; Elderly; Emergency Care; Emergency Medicine; Emergency Nursing; Emergency Situation; Environment; Event; Family; Feeling; Fever; Genus Cola; Goals; Health; Heart Arrest; Home environment; Hospice Care; Hospitals; Hour; Incidence; Institute of Medicine (U.S.); Institution; Intervention; Knowledge; Learning; Life; Link; Literature; Lung; Malignant Neoplasms; Malignant neoplasm of gastrointestinal tract; Malignant neoplasm of lung; Marketing; Medicaid; Medicare; Minority; Modeling; National Cancer Policy Board; Nausea and Vomiting; Numbers; Nurses; Nursing Education; Oncologist; Outcome; Pain; Palliative Care; Patient Care; Patients; Phase; Physicians; Primary Health Care; Prostate; Protocols documentation; Provider; Psychosocial Assessment and Care; Recommendation; Recruitment Activity; Research; Research Personnel; Residencies; Series; Severities; Shortness of Breath; Site; Stress; Symptoms; Terminally Ill; Textbooks; Time; Trainers Training; Training; United States; Visit; base; cancer care; cancer diagnosis; day; depressive symptoms; design; education evaluation; end of life care; experience; hospice environment; improved; medical specialties; oncology; programs; psychologic; service intervention; skills; social; ward

DESCRIPTION (provided by applicant): Of 28,777 patients 65 yrs or more who died within a year of a diagnosis of lung, breast, or gastrointestinal cancer, >9% had one or more Emergency Department (ED) visits in the last month of life. Many cancer patients also have an ED visit for a cancer-related issue long before their final days. There were 2.1 million cancer-related visits to the ED in the United States between 1997 and 2000. Cancer patients who visit the ED have a high symptom burden, with, on average, over the midway mark on common symptom severity scales. ED's are a refuge for cancer patients in the event of acute exacerbation of symptoms or illness. This is especially so for those of minority status. However, emergency medicine (EM) clinicians have minimal palliative care training. Cancer patients' care goals are often needlessly redirected during an ED visit, and symptoms remain needlessly uncontrolled. Therefore, consistent with the Institute of Medicine and the National Cancer Policy Board's call for the integration of palliative care for patients with cancer and other diseases, we will create: 1. a curriculum-driven, train-the-trainer emergency oncology palliative care education program, and 2. extend its impact in two strategic sites by coupling it with clinical practice reminders linked to curriculum learning objectives. We will evaluate the program's impact on attitudes, knowledge and skills as well as dissemination. For the second part we will also evaluate its impact on clinical behaviors and patient-related clinical outcomes. The program will be modeled on the high-impact Education on Palliative & End-of-life Care (EPEC) Project, and will be called the EPEC-EM Project. Dissemination will be by creation, in partnership with EM specialty associations, of 65 physician and 65 nurse EPEC-EM Trainers. Trainers will be recruited through merit- selected application from EM residency program directors and their program nurse. Trainers will then teach colleagues from their own ED and others beyond their institution, to reach approximately 9,795 end users. We will then provide EPEC-EM education coupled with the clinical reminders, creating one comprehensive intervention to 'blanket' the EDs at the Northwestern Memorial Hospital and Emory's Crawford Long Memorial Hospital. This education+reminders intervention will use an interrupted time-series design. This portion of the project allows us to extend the usual education evaluation to include not only improvement in clinicians' attitudes, knowledge and some skills, but also in clincial behaviours and patient outcomes.

描述（由申请人提供）：在28,777名65岁或65岁以上的患者中，在诊断为肺癌，乳腺癌或胃肠道癌症后一年内死亡，其中bb90 %的患者在生命的最后一个月就诊过一次或多次急诊科（ED）。许多癌症患者在临终前很久就因为癌症相关问题去了急诊科。在1997年到2000年之间，美国有210万与癌症相关的急诊科就诊。到急诊科就诊的癌症患者有很高的症状负担，平均而言，在常见症状严重程度量表上超过了中间标记。急诊科是癌症患者在症状或疾病急性恶化时的避难所。对于那些少数民族来说尤其如此。然而，急诊医学（EM）临床医生只有很少的姑息治疗培训。在急诊科就诊期间，癌症患者的护理目标往往被不必要地重新定向，而症状也没有必要地得不到控制。