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: 8448508
• 负责人: MARCIA McDonnell Holstad
• 金额: $ 46.8万
• 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 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8448508
• 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; 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; Stigmata; Stroke; Supportive care; Symptoms; Testing; Time; Visit; antiretroviral therapy; behavior change; coping; cost; cost effective; cost effectiveness; efficacy testing; gastrointestinal; improved; innovation; inpatient service; life time cost; mortality; motivational enhancement therapy; multidisciplinary; programs; psychologic; psychosocial; 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. PUBLIC HEALTH RELEVANCE: Early Palliative Care and MI for Persons with AIDS Project Narrative The overall goal of this project is to implement and test the efficacy of an enhanced comprehensive multidisciplinary early palliative care package that includes four motivational interviewing sessions (EPC) for persons newly diagnosed with AIDS. We posit that the innovative EPC will improve quality of life, clinical and psychosocial outcomes and advance care planning in a cost effective manner and could promote engagement and retention in HIV care. If successful, it could serve as a model of early palliative care for persons with AIDS in the US.

描述（由申请人提供）：现在建议在诊断出危及生命的疾病时进行早期姑息治疗。我们计划测试早期姑息治疗（EPC）服务的增强模式的有效性，为新诊断为艾滋病的人，并承认无论是住院服务或门诊传染病计划（IDP）在格雷迪卫生系统在亚特兰大，GA（GHS）。我们的艾滋病EPC套餐包括3次姑息治疗访视和4次每周一次的动机访谈（MI），以提供支持性护理，症状管理，并促进诊断和提前护理计划决策的调整。该项目有三个具体目标：1。进行一项随机对照试验，以检查艾滋病EPC包干预与标准HIV护理（SOC）的疗效，并比较基线后12个月的结局。我们的假设是，艾滋病EPC组将有：i）更好的临床结果：较低的一年死亡率，较高的比例谁开始抗逆转录病毒治疗（ART），较高的比例与病毒抑制，较高的CD 4增益，较少的机会性感染（OI），较少的住院治疗，较低的抑郁评分，和更好的症状管理（包括认知功能障碍）。ii）更好的心理社会结果：更好的应对技能，更高的感知社会支持，更高的灵性，更高的自我宣传水平，更低的 报告使用药物的比例。iii）更好的生活质量（QOL）和更高比例的人报告提前护理计划活动：指定代理人;设定有关救生措施的个人目标;并与代理人讨论这些目标。2.评价艾滋病EPC包与SOC相比的成本效益和成本效用，SOC的结局分别被评价为生存期和质量调整生命年（QDR）。3.促进艾滋病毒护理的参与和保留，保持较高比例的预约和报告更高的满意度与SOC相比，我们认为姑息治疗（PC）-重点是支持性的，以患者为导向的护理-是一种理想的方法，以优化新诊断的艾滋病患者的治疗，并促进参与和保留护理。全面和多学科管理的艾滋病EPC包包括精神，社会，心理，认知和症状管理，并增加了每周四次的一对一的动机访谈会议由护士进行，以促进疾病的调整和决策有关的提前护理计划。我们认为，在新诊断的艾滋病患者的护理中整合EPC将大大改善QOL，临床和心理社会结果，并以低于标准护理的成本推进护理计划。这种关怀的方法将提高参与和保持护理，并促进个人自我宣传和生活质量的运动。 公共卫生关系：艾滋病患者早期姑息治疗和MI项目叙述该项目的总体目标是实施和测试增强型综合多学科早期姑息治疗包的有效性，该包包括针对新诊断为艾滋病的患者的四次动机访谈（EPC）。我们认为，创新的EPC将改善生活质量，临床和心理社会结果，并以具有成本效益的方式推进护理规划，并可以促进艾滋病毒护理的参与和保留。如果成功，它可以作为美国艾滋病患者早期姑息治疗的典范。