Palliative Care Symptom Management in Rural Communities

农村社区姑息治疗症状管理

• 批准号: 8183557
• 负责人: Ardith Z Doorenbos
• 金额: $ 50.12万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-12 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8183557
• 关键词: Address; Anxiety; Attitude; Cancer Patient; Caregivers; Caring; Case Management; Chronic; Clinical; Clinical Trials Design; Communication; Communities; Competence; Constipation; Consultations; Control Groups; Distant; Distress; Dyspnea; Effectiveness; Effectiveness of Interventions; Evidence based practice; Experimental Designs; Face; Family member; Fatigue; Financial cost; Goals; Health; Health Care Visit; Health Personnel; Health Services; Healthcare; Home Care Services; Home environment; Improve Access; Intervention; Knowledge; Life; Link; Mental Depression; Methods; Modeling; Outcome; Outcome Study; Pain; Palliative Care; Patient Care; Patient Participation; Patient Self-Report; Patients; Population Density; Poverty; Provider; Quality of life; Quality-Adjusted Life Years; Randomized; Randomized Clinical Trials; Reporting; Research; Research Infrastructure; Resources; Rural; Rural Community; Rural Health; Rural Population; Self Assessment; Services; Severities; Solutions; Specialist; Symptoms; Technology; Testing; Time; Training Support; Travel; Underinsured; Uninsured; United States; Videoconferences; Videoconferencing; Visit; care delivery; case-based; cost; cost effective; cost effectiveness; disability; effective intervention; evidence base; group intervention; health care delivery; health care service utilization; health disparity; improved; intervention effect; medical specialist; medical specialties; palliative; peer; programs; randomized trial; rural area; symposium; symptom management; telehealth

DESCRIPTION (provided by applicant): Palliative care aims to provide relief of pain and other patient symptoms, such as fatigue, dyspnea, constipation, anxiety, and depression, in order to improve quality of life. Patients in isolated rural settings often lack easy access to palliative care and other specialist services. Yet rural residents are more likely than their urban counterparts to be older; be in poorer overall health; suffer from more chronic or serious illnesses and disabilities; be uninsured or underinsured; and live in poverty. Telehealth is an emerging method of health care delivery that has been found useful and effective in many clinical settings and specialties. Telehealth technologies can bridge geographic distance and increase access to specialist care in rural settings. We propose a cluster randomized clinical trial design to test the effects of a telehealth-enhanced palliative care symptom-management program for 288 cancer patients and 96 providers in rural health care settings. The proposed program will provide services to both patients and providers: Patients will conduct self-assessments and report pain and other symptoms via telehealth. Health care providers will receive telehealth-delivered case consultations that will include case management, evidence-based practice resources, and peer support. Providers and their patients will be randomly assigned to intervention groups, which receive the telehealth- enhanced palliative care symptom-management intervention, or to control groups. Our primary aim is to compare patient self-reports of symptoms and quality of life in the intervention and control groups over 2 months. Aim 2 is to examine, in the intervention and control groups over 2 months, providers' knowledge and attitudes regarding symptoms and perceived competence in treating symptoms. Aim 3 is to evaluate the cost- effectiveness of the telehealth intervention. We will use mixed effects models with patients nested within providers to evaluate the effect of the intervention on study outcomes. Findings from this study will be instrumental in advancing telehealth and improving symptom management and palliative care among underserved rural populations. PUBLIC HEALTH RELEVANCE: Rural patients face many health disparities, including challenges in obtaining palliative care for relief of pain and other distressing symptoms. This study will evaluate the effectiveness of a telehealth-enhanced palliative care symptom-management intervention for rural cancer patients and their health care providers. The findings of this study will be instrumental in enhancing symptom management and palliative care, which will have applicability to delivery of other specialist care among underserved rural populations.

描述（由申请人提供）：姑息治疗旨在缓解疼痛和其他患者症状，如疲劳、呼吸困难、便秘、焦虑和抑郁，以提高生活质量。偏远农村地区的患者往往难以获得姑息治疗和其他专科服务。然而，农村居民比城市居民更有可能年龄更大;总体健康状况更差;患有更多慢性或严重疾病和残疾;没有保险或保险不足;生活贫困。远程医疗是一种新兴的医疗保健提供方法，已被发现在许多临床环境和专业中有用和有效。远程保健技术可以弥合地理距离，增加农村地区获得专家护理的机会。我们提出了一个集群随机临床试验设计，以测试远程医疗增强姑息治疗的疾病管理计划的288名癌症患者和96个供应商在农村医疗机构的影响。拟议的计划将为患者和提供者提供服务：患者将进行自我评估，并通过远程医疗报告疼痛和其他症状。卫生保健提供者将接受远程保健提供的病例咨询，其中包括病例管理、循证实践资源和同行支持。提供者和他们的病人将被随机分配到干预组，接受远程保健增强的姑息治疗管理干预，或对照组。我们的主要目的是比较两个月内干预组和对照组患者自我报告的症状和生活质量。目的2是在2个月以上的干预组和对照组中检查提供者对症状的知识和态度以及治疗症状的感知能力。目的3是评价远程健康干预的成本-效果.我们将使用混合效应模型，将患者嵌套在提供者中，以评估干预对研究结果的影响。这项研究的结果将有助于推进远程保健，改善服务不足的农村人口的症状管理和姑息治疗。 公共卫生关系：农村患者面临许多健康差距，包括在获得缓解疼痛和其他痛苦症状的姑息治疗方面的挑战。本研究将评估远程医疗增强姑息治疗的有效性，为农村癌症患者和他们的医疗保健提供者的疾病管理干预。本研究的结果将有助于加强症状管理和姑息治疗，这将适用于为服务不足的农村人口提供其他专业护理。