The Living Well Project: Early Palliative Care and MI for persons with AIDS

美好生活项目：艾滋病患者的早期姑息治疗和心肌梗死

• 批准号: 9100440
• 负责人: MARCIA McDonnell Holstad
• 金额: $ 42.38万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-27 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9100440
• 关键词: AIDS diagnosis; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adherence; Advance Care Planning; Advocacy; Alcohol or Other Drugs use; Anti-Retroviral Agents; Appointment; Appointments and Schedules; Caring; Cessation of life; Chronic; Clinical; Communicable Diseases; Consensus; Coping Skills; Cost utility; Decision Making; Diagnosis; Disease; Early treatment; Enrollment; Fatigue; Goals; HIV; Health; Health system; Hospitalization; Impaired cognition; Intervention; Life; Link; Measures; Mental Depression; Methods; Modeling; Moods; Movement; Names; Neurobehavioral Manifestations; Newly Diagnosed; Nurses; Opportunistic Infections; Outcome; Outpatients; Pain; Palliative Care; Patient Care; Patients; Persons; Pharmaceutical Preparations; Quality of life; Quality-Adjusted Life Years; Recruitment Activity; Regimen; Reporting; Services; Social support; Spirituality; Stroke; Supportive care; Symptoms; Testing; Time; Visit; antiretroviral therapy; behavior change; coping; cost; cost effective; cost effectiveness; depressive symptoms; efficacy testing; gastrointestinal; improved; innovation; inpatient service; life time cost; mortality; motivational enhancement therapy; multidisciplinary; physical symptom; programs; psychologic; psychosocial; reduce symptoms; routine care; satisfaction; social; social stigma; standard care; symptom management

DESCRIPTION (provided by applicant): Early palliative care is now recommended for persons at the time of diagnosis of a life threatening illness. We plan to test the efficacy of an enhanced model of early palliative care (EPC) services for persons newly diagnosed with AIDS and admitted to either the inpatient service or outpatient infectious disease program (IDP) at the Grady Health System in Atlanta, GA (GHS). Our AIDS EPC Package includes 3 palliative care visits and four weekly motivational interviewing (MI) sessions to provide supportive care, symptom management, and facilitate adjustment to diagnosis and advance care planning decision making. The project has three specific aims: 1. Conduct a RCT to examine the efficacy of the AIDS EPC Package intervention vs. standard HIV care (SOC) and compare outcomes at 12 months post baseline. Our hypothesis is that those in the AIDS EPC group will have: i) Better clinical outcomes: a lower one year mortality, higher proportion who initiate antiretroviral therap (ART), higher proportion with virologic suppression, higher CD4 gain, fewer opportunistic infections (OI), fewer hospitalizations, lower depression scores, and better symptom management (including cognitive dysfunction). ii) Better psychosocial outcomes: Better coping skills, higher perceived social support, higher spirituality, higher levels of self-advocacy, lower proportion who report substance use. iii) Better Quality of Life (QOL) and a higher proportion who report advance care planning activities: named a surrogate; set personal goals regarding life saving measures; and discussed these goals with a surrogate. 2. Evaluate the cost effectiveness and cost utility of the AIDS EPC Package compared to SOC where the outcomes are valued as survival and quality-adjusted life years (QALYs) respectively. 3. Promote engagement and retention in HIV care as evidenced by keeping a higher proportion of appointments and reporting higher satisfaction with care compared to SOC. We believe palliative care (PC) - with a focus on supportive, symptom-oriented care - is an ideal method to optimize the treatment of newly diagnosed persons with AIDS and promote engagement and retention in care. The comprehensive and multidisciplinary administered AIDS EPC Package includes spiritual, social, psychological, cognitive, and symptom management, with the addition of four weekly one-on-one motivational interviewing sessions conducted by nurses to facilitate disease adjustment and decision making about advance care planning. We posit that integrating EPC in the care of newly diagnosed AIDS patients will greatly improve QOL, clinical and psychosocial outcomes, and advance care planning at a lower cost than standard care. This caring approach will enhance engagement and retention in care and promote movement toward personal self-advocacy and quality of life.

描述(由申请人提供)：现在建议在诊断出危及生命的疾病时及早进行姑息治疗。我们计划在佐治亚州亚特兰大的Grady Health System(GHS)测试早期姑息治疗(EPC)服务的增强模式对新诊断为艾滋病并进入住院服务或门诊传染病计划(IDP)的人的有效性。我们的艾滋病EPC套餐包括3次姑息关怀访问和4次每周动机访谈(MI)会议，以提供支持性护理、症状管理、促进诊断调整和高级护理规划决策。该项目有三个具体目标：1.进行随机对照试验，以检查艾滋病EPC一揽子干预措施与标准艾滋病毒护理(SOC)的疗效，并比较基线后12个月的结果。我们的假设是，艾滋病EPC组的患者将有：i)更好的临床结果：一年死亡率更低，开始抗逆转录病毒疗法(ART)的比例更高，接受病毒抑制的比例更高，CD4增加更高，机会性感染(OI)更少，住院次数更少，抑郁评分更低，症状管理(包括认知功能障碍)更好。二)更好的心理社会成果：更好的应对技能、更高的社会支持意识、更高的灵性、更高的自我宣传水平、更低的 报告药物使用情况的比例。3)更高的生活质量(QOL)和更高比例的人报告提前护理计划活动：指定代孕者；设定关于拯救生活措施的个人目标；并与代孕者讨论这些目标。2.与SOC相比，评估AIDS EPC包的成本效益和成本效用。在SOC中，结果分别以生存年和质量调整寿命年(QALY)来评估。3.与SOC相比，通过保持更高的预约比例和对护理的更高满意度，促进艾滋病毒护理的参与度和保留率。我们认为，姑息治疗(PC)--侧重于支持性的、以症状为导向的护理--是优化新诊断的艾滋病患者的治疗并促进参与和保持护理的理想方法。全面和多学科管理的艾滋病EPC一揽子计划包括精神、社会、心理、认知和症状管理，并增加了每周四次由护士进行的一对一励志访谈会议，以促进疾病调整和关于高级护理计划的决策。我们认为，将EPC整合到新诊断的艾滋病患者的护理中将极大地改善生活质量、临床和心理社会结果，并以比标准护理更低的成本推进护理计划。这种关爱的方法将提高关爱的参与度和保留率，并促进个人自我倡导和生活质量的发展。