Improving patient outcomes in end-of-life care provided by physicians and nurses

改善医生和护士提供的临终关怀的患者结局

• 批准号: 8038446
• 负责人: J Randall Curtis
• 金额: $ 71.22万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-06-11 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8038446
• 关键词: Affect; Attitude; Cancer Patient; Caring; Cessation of life; Chronic; Communication; Control Groups; Effectiveness; Effectiveness of Interventions; Elderly; Evaluation; Faculty; Family; Family Nursing; Family member; Funding; Goals; Happiness; Health Knowledge, Attitudes, Practice; Heart Diseases; Interdisciplinary Communication; Internal Medicine; Intervention; Knowledge; Life; Liver diseases; Lung diseases; Malignant Neoplasms; Measures; Medical center; National Cancer Institute; Nurse Practitioners; Nurses; Outcome; Outcome Measure; Pain; Patient Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Performance; Physicians; Population Scientist Supplement (R25); Process; Process Measure; Questionnaires; Randomized; Randomized Controlled Trials; Research; Research Design; Research Personnel; Residencies; Sample Size; Self Assessment; Students; Surveys; Symptoms; Testing; Training; Training Programs; United States; design; end of life; experience; improved; innovation; intervention effect; oncology; patient oriented; primary outcome; programs; randomized trial; secondary outcome; skills; success

DESCRIPTION (provided by applicant): Three decades of research on end-of-life care in the U.S. indicate that patients frequently die with a significant burden of pain and other symptoms and often receive care that they would not choose. Patient- clinician communication about end-of-life care is an important focus for improving quality of patient-centered end-of-life care. Studies suggest that clinicians can improve their communication skills with experiential training, but no studies have shown that an intervention to improve clinician communication skill about end- of-life care improves patient outcomes. Furthermore, despite the knowledge that end-of-life care is best delivered in an interdisciplinary context, most studies do not incorporate interdisciplinary training. We propose to build on a state-of-the-art intervention, developed and implemented for oncology fellows through an R25 award funded by the National Cancer Institute, which is designed to improve clinician skills at communicating about end-of-life care. We will adapt the intervention for use in internal medicine and nurse practitioner training programs, one in the Northwest and one in the Southeast, and incorporate an innovative interdisciplinary training component. We will evaluate the intervention with patient-level outcomes using a questionnaire for assessing the quality of end-of-life care developed and validated in a prior RO1. The evaluation will target patients with cancer, patients with chronic heart, lung, or liver disease, and older adults. For internal medicine residents (n=291), the study design will be a randomized trial. For nurse practitioner (NP) students (n=96), we will use a before-after study design to accommodate sample size limitations. The primary aim is to evaluate the effectiveness of the communication intervention to improve the end-of- life care delivered by residents and NP students. The primary outcome measures are patient and family ratings of end-of-life care. As secondary outcomes, we will examine patient symptoms and end-of-life care as assessed by nurses. Secondary aims are: 1) to assess the intervention's success using process measures, including a validated knowledge test and attitudes survey, standardized patients, and learner self- assessment; and 2) to examine learner factors that facilitate or impede the effectiveness of the communication intervention to improve the quality of end-of-life care as assessed with both process (knowledge, attitudes, and behaviors) and outcome measures (patient and family ratings). This study will provide important information regarding the implementation and effectiveness of an interdisciplinary communication skills intervention for physicians and nurses with the goal of improving end- of-life care for patients and their families and reducing symptoms. The study will test the effectiveness of the intervention with patient- and family-level outcomes. If the intervention is effective, it offers the opportunity to improve the end-of-life care received by patients and their families throughout the US.

描述（由申请人提供）：美国对临终关怀的三十年研究表明，患者经常因疼痛和其他症状而死亡，并且经常接受他们不会选择的护理。临终关怀的医患沟通是提高以患者为中心的临终关怀质量的重要焦点。研究表明，临床医生可以通过体验式培训提高他们的沟通技能，但没有研究表明，提高临床医生关于临终关怀的沟通技能的干预措施可以改善患者的预后。此外，尽管知道临终关怀最好在跨学科的背景下提供，大多数研究没有纳入跨学科的培训。我们建议建立一个国家的最先进的干预措施，通过由国家癌症研究所资助的R25奖为肿瘤学研究员开发和实施，旨在提高临床医生在沟通临终关怀方面的技能。我们将调整干预用于内科和护士执业培训计划，一个在西北，一个在东南，并纳入创新的跨学科培训组成部分。我们将使用一份问卷来评估在先前的RO 1中开发和验证的临终关怀质量，以评估患者水平结局的干预措施。该评估将针对癌症患者，慢性心脏病，肺病或肝病患者以及老年人。对于内科住院医师（n=291），研究设计为随机试验。对于执业护士（NP）学生（n=96），我们将使用前后研究设计，以适应样本量限制。主要目的是评估沟通干预的有效性，以改善居民和NP学生提供的临终关怀。主要结果指标是患者和家属对临终关怀的评分。作为次要结果，我们将检查护士评估的患者症状和临终关怀。次要目标是：1）使用过程测量评估干预的成功，包括有效的知识测试和态度调查，标准化患者和学习者自我评估;以及2）检查促进或阻碍沟通干预有效性的学习者因素，以提高生命终末护理的质量，（知识，态度和行为）和结果测量（患者和家庭评级）。这项研究将提供重要的信息，为医生和护士提供跨学科沟通技能干预的实施和有效性，其目标是改善患者及其家属的临终关怀并减少症状。该研究将测试干预措施的有效性，包括患者和家庭层面的结果。如果干预措施有效，它将为改善美国各地患者及其家属所接受的临终关怀提供机会。

项目成果

Physicians' and Nurse Practitioners' Level of Pessimism About End-of-Life Care During Training: Does It Change Over Time?

医生和护士在培训期间对临终关怀的悲观程度：它会随着时间的推移而改变吗？

• DOI: 10.1016/j.jpainsymman.2015.11.024
• 发表时间: 2016
• 期刊: Journal of pain and symptom management
• 影响因子: 4.7
• 作者: Long,AnnC;Downey,Lois;Engelberg,RuthA;Ford,DeeW;Back,AnthonyL;Curtis,JRandall
• 通讯作者: Curtis,JRandall

Life-sustaining treatment preferences: matches and mismatches between patients' preferences and clinicians' perceptions.

• DOI: 10.1016/j.jpainsymman.2012.07.002
• 发表时间: 2013-07
• 期刊: JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
• 影响因子: 4.7
• 作者: Downey, Lois;Au, David H.;Curtis, J. Randall;Engelberg, Ruth A.
• 通讯作者: Engelberg, Ruth A.

Training for effective patient communication--reply.

有效患者沟通培训--答复。

• DOI: 10.1001/jama.2014.1475
• 发表时间: 2014
• 期刊: JAMA
• 作者: Curtis,JRandall;Back,AnthonyL;Engelberg,RuthA
• 通讯作者: Engelberg,RuthA