Pilot Study of Standardized PatiEnt-CenTered medicatiOn Review (SPECTORx) in Home Hospice

项目摘要/摘要 家庭临终关怀的一个巨大挑战是确保药物处方 适当地与患者的护理目标保持一致，并适当地管理药物 由家庭照顾者。因此，我们提出了一种新的干预措施，将临终关怀工作人员培训到1人。 定期审查、简化患者的处方药物，并使之与他们的护理目标保持一致 他们的病情恶化，以及2.为家庭照顾者提供教育，使他们能够 了解每种药物的用法，培养安全用药的技能，并了解何时 停止用药可能是有益的。这项计划被称为标准化患者- 家庭临终关怀中心用药审查(SPECTORx)，基于 三个现有的、互补的教育项目的组合，共同培训临终关怀 工作人员创建全面的、以患者为中心的药物管理护理计划。这个 该计划还创建了一个在线学习社区，以促进持续教育和 临终关怀临床医生的实践变革。这项R21试点研究旨在论证 进行临床试验以评估SPECTORx的疗效。长期目标是 检验SPECTORx减少不适当用药和改善用药的假设 家庭照顾者报告了护理质量。然而，要做到这一点，我们必须首先解决 关于家庭临终关怀试验的设计、可行性和执行方面的挑战性问题。 我们将使用利益相关者参与流程来完善SPECTORx 干预和试验方案。然后，我们将进行试点集群随机试验和比较 来自犹他州和澳大利亚的两家大型、多办公室临终关怀机构内部和之间的成果 马萨诸塞州。在每个临终关怀机构中，我们将随机选择1个办公室进行干预，1个 办公室呼叫控制中心。目标登记人数为n=60名家庭护理者-患者双方 65岁的≥患有晚期、限制生命的疾病。主要结果是可接受性和 安宁疗养院利益相关者实施SPECTORx干预的可行性、可接受性和负担 和完成家庭照顾者评估(家庭照顾者用药管理 基线、2周、4周、12周和季度的Hassle量表)。的首要目标是 这项研究是为了使患者的处方药物与他们在每个阶段的护理目标相一致 他们的晚期疾病，并支持家庭照顾者的用药管理挑战。 最终，我们希望提高药物处方的质量，减少治疗 复杂性和与药物相关的伤害，并改善家庭照顾者的结局 每年有6亿美国老年人接受家庭临终关怀服务。

PROJECT SUMMARY/ABSTRACT A tremendous challenge in home hospice care is ensuring that medication prescribing is appropriately aligned to patients’ goals of care and that medications are appropriately managed by family caregivers. Therefore, we propose a novel intervention that trains hospice staff to 1. regularly review, simplify, and align patients’ prescribed medications with their goals of care as their illness progresses, and 2. support family caregivers with education that empowers them to understand each medication’s use, develop skills for safe administration, and understand when stopping medications may be beneficial. This program is called Standardized PatiEnt- CenTered medicatiOn Review (SPECTORx) in Home Hospice, and is based on a combination of 3 existing, complementary, educational programs that, together, train hospice staff to create a comprehensive, patient-centered, medication management care plan. The program also creates an online learning community that promotes ongoing education and practice change for hospice clinicians. This R21 pilot study aims to demonstrate the feasibility of conducting a clinical trial to evaluate the efficacy of SPECTORx. The long-term objective is to test the hypothesis that SPECTORx reduces inappropriate medication prescribing and improves family caregiver reported quality of care. However, to accomplish this, we must first address challenging questions regarding the design, feasibility, and execution of trials in home hospice. We will accomplish this using a stakeholder engagement process to refine the SPECTORx intervention and trial protocol. We will then conduct a pilot cluster randomized trial and compare outcomes within and across 2 large, multi-office, hospice agencies from Utah and Massachusetts. Within each hospice agency, we will randomize 1 office to intervention and 1 office to attention control. Target enrollment is n=60 family caregiver-patient dyads of patients aged ≥65 years with advanced, life-limiting illness. Primary outcomes are acceptability and feasibility of the SPECTORx intervention by hospice stakeholders, and acceptability, burden and completion of family caregiver assessments (Family Caregiver Medication Administration Hassle Scale at baseline, 2 weeks, 4 weeks, 12 weeks, and quarterly). The overarching goal of this research is to align patient’s prescribed medications with their goals of care at each stage of their advanced illness and to support family caregivers’ medication management challenges. Ultimately, we want to improve the quality of medication prescribing, reduce treatment complexity and medication-related harm, and improve family caregiver outcomes for the almost 600,000 million elderly Americans who receive home hospice services annually.