Palliative Care Symptom Management in Rural Communities

描述(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，与城市居民相比，农村居民更有可能变老；整体健康状况较差；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，在许多临床环境和专科中被发现是有用和有效的。远程医疗技术可以弥合地理距离，并增加农村地区获得专家护理的机会。我们提出了一项整群随机临床试验设计，以测试远程医疗增强的姑息治疗症状管理计划的效果，该计划针对288名癌症患者和96名农村医疗保健提供者。拟议的计划将向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医疗提供的病例咨询，其中将包括病例管理、循证实践资源和同行支持。提供者和他们的患者将被随机分配到干预组，接受远程医疗增强的姑息治疗症状管理干预，或对照组。我们的主要目的是比较干预组和对照组在2个月内的症状和生活质量的患者自我报告。目标2是在两个多月的时间里，在干预组和对照组中检查提供者对症状的知识和态度，以及在治疗症状方面的感知能力。目的3是评估远程保健干预的成本效益。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。

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.