ENABLE: CHF-PC (Comprehensive Heartcare For Patients and Caregivers)

ENABLE：CHF-PC（针对患者和护理人员的综合心脏护理）

• 批准号: 9221577
• 负责人: Marie Anne Bakitas
• 金额: $ 7.8万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-01 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9221577
• 关键词: Address; Admission activity; Advance Care Planning; Advanced Malignant Neoplasm; Affect; Age; Alabama; American; Anxiety; Cancer Model; Cancer Patient; Caregiver Burden; Caregivers; Caring; Cessation of life; Characteristics; Chronic Disease; Communication; Consensus; Continuity of Patient Care; Decision Making; Diagnosis; Disease; Distress; Economics; Elderly; Elements; Emergency Situation; Emotional; Environment; Family; Family Caregiver; Foundations; Goals; Health; Heart; Heart failure; Hospitalization; Hospitals; Intervention; Joints; Knowledge; Life; Measurable; Mediating; Mediator of activation protein; Medical; Medical center; Medicare; Mental Depression; Minority; Mission; Modeling; Moods; Morbidity - disease rate; Nurses; Outcome; Palliative Care; Participant; Patient Care; Patient Self-Report; Patients; Persons; Pilot Projects; Population; Positioning Attribute; Problem Solving; Procedures; Public Health; Quality of life; Race; Randomized; Randomized Controlled Trials; Reporting; Research; Resources; Risk Factors; Rural; Rural Population; Science; Self Care; Services; Social support; Solid; Staging; Statistical Methods; Supportive care; Symptoms; System; Testing; Universities; Veterans; Visit; World Health Organization; aged; base; cancer palliative treatment; caregiver interventions; coping; economic cost; efficacy testing; end of life; experience; health care delivery; health literacy; hospice environment; human old age (65+); improved; innovation; instrument; intervention effect; model design; mortality; novel; older patient; outcome forecast; palliative; pragmatic trial; reduce symptoms; routine care; rural area; skills; social; symptom management; telehealth

 DESCRIPTION (provided by applicant): Almost 5 million Americans, most over age 65, carry a diagnosis of heart failure (HF). Despite treatment advances, 50% will die within 5 years; increasing age and rural environment are risk factors associated with the greatest HF morbidity and mortality. In the year before death, HF patients will experience multiple hospitalizations and personal and economic costs of unrelieved physical and emotional suffering. Currently, only 19% of Medicare-aged HF patients (and their family caregivers) access beneficial palliative care services, compared with more than half of advanced cancer patients. Older patients with HF and their caregivers, rarely have access to palliative supportive care services because the disease is unpredictable and palliative treatment may not be provided until after other medical treatments have been tried. We and others have demonstrated in advanced cancer that concurrent palliative care achieves beneficial outcomes in quality of life (QOL), symptom burden, depression, and in some case survival. The intervention is adapted from our successful palliative care model for cancer (ENABLE: Educate, Nurture, Advise, Before-Life- Ends). Our overall goal is to test the efficacy of a concurrent HF palliative care model in reducing the morbidity of living with advanced HF. This randomized controlled trial (RCT) will compare the quality of life, symptom burden, mood, and the quality of chronic illness and end-of-life care in 380 older adults with NYHA stage III/IV HF and 228 caregivers. Half of the patient participants (n=190) will be randomized to the intervention and half (n=190) will receive usual HF care. The specific aims of the RCT; ENABLE: CHF-PC (Comprehensive Heart care for Patients and Caregivers), are to 1) Determine whether ENABLE: CHF-PC leads to higher advanced HF patient-reported QOL and mood (depression/anxiety); and lower symptom burden and resource use (e.g. hospital admissions and days, emergency visits) at 8 and 16 weeks after baseline and to 2) Determine whether ENABLE: CHF-PC leads to higher caregiver-reported QOL, mood (anxiety/depression), and self-reported health and lower caregiver burden at 8 and 16 weeks after baseline. The relevance of this research to public health is that there is an urgent need to improve the routine care of older adults in rural areas with advanced heart failure and their caregivers. This study will contribute substantially to that effort.

 描述（由申请人提供）：近 500 万美国人（大多数年龄超过 65 岁）被诊断患有心力衰竭 (HF)。尽管治疗取得了进展，但 50% 的人将在 5 年内死亡；年龄增长和农村环境是心力衰竭发病率和死亡率最高的危险因素。在死亡前一年，心力衰竭患者将经历多次住院治疗以及无法缓解的身体和情感痛苦带来的个人和经济损失。目前，只有 19% 的医疗保险年龄的心力衰竭患者（及其家庭护理人员）获得有益的姑息治疗服务，而晚期癌症患者的比例超过一半。老年心力衰竭患者及其护理人员很少获得姑息支持性护理服务，因为这种疾病是不可预测的，并且在尝试其他药物治疗后可能无法提供姑息治疗。我们和其他人已经证明，在晚期癌症中，同步姑息治疗可以在生活质量（QOL）、症状负担、抑郁以及某些情况下的生存方面取得有益的结果。该干预措施改编自我们成功的癌症姑息治疗模式（启用：教育、培育、建议、临终前）。我们的总体目标是测试并发心力衰竭姑息治疗模式在降低晚期心力衰竭发病率方面的功效。这项随机对照试验 (RCT) 将比较 380 名 NYHA III/IV 期 HF 老年人和 228 名护理人员的生活质量、症状负担、情绪以及慢性病和临终护理的质量。一半患者参与者 (n=190) 将被随机分配接受干预，一半 (n=190) 将接受常规心力衰竭护理。 RCT 的具体目标； ENABLE：CHF-PC（针对患者和护理人员的综合心脏护理）旨在 1) 确定 ENABLE：CHF-PC 是否会导致晚期心力衰竭患者报告的生活质量和情绪（抑郁/焦虑）更高；基线后 8 周和 16 周时症状负担和资源使用（例如入院和住院天数、急诊就诊）降低，并 2) 确定启用：CHF-PC 是否会导致基线后 8 周和 16 周时看护者报告的生活质量、情绪（焦虑/抑郁）和自我报告的健康状况更高，并降低看护者负担。这项研究与公共卫生的相关性在于，迫切需要改善农村地区患有晚期心力衰竭的老年人及其护理人员的常规护理。这项研究将为这一努力做出重大贡献。