In-Touch: Implementation of a person-centered palliative care iNtervention To imprOve comfort, QUality of Life and social engagement of people with advanced dementia in Care Homes

挑战。在欧洲，越来越多的晚期痴呆症患者和需要姑息治疗的人住在养老院，照顾他们既困难又费力。患有晚期痴呆症的人可能行动不便，无法言语，无法参加日常活动。他们可能会不安或激动，生活质量低，不适程度增加。家庭成员会发现很难与亲人建立有意义的联系，并对未来感到焦虑。护理人员可能很难提供除喂养、如厕和皮肤护理等基本需求之外的护理。解决方案。这是一种超越科学的合乎道德的解决方案，既提供“当下”的护理（使用合十礼护理），又为未来的护理需求进行规划（使用家庭护理决策支持“舒适护理”方法）。我们称之为In-Touch干预。计划。在7个国家的56家养老院进行InTouch干预的跨国随机对照试验，以确定其对舒适度、社会参与和生活质量的影响。这得到了9个工作包的支持，确保：干预措施得到强有力的规划，并根据不同的国家环境进行调整；要理解它是如何传递的，以及人们对干预的体验和道德价值；成本效益是了解的；如果干预成功，我们有有效的计划来传递有关干预的知识。的影响。这一干预措施可能预示着在整个欧洲为晚期痴呆症患者提供姑息期护理的方式将发生重大变化。晚期痴呆症患者在接近死亡时应该有更好的生活质量，提高参与度，减少社会孤立。护理人员将有合乎道德的、以证据为基础的、具有成本效益的干预措施，使家庭成员更多地参与并了解舒适护理和未来护理计划。

Challenge. Caring for the increasing numbers of people across Europe with advanced dementia and palliative care needs who live in care homes is difficult and demanding. People with advanced dementia can be immobile, non-verbal and unable to take part in day-today activities. They can be unsettled or agitated, with low quality-of-life and elevated levels of discomfort. Family members can find it difficult to connect meaningfully with their relative and are anxious about the future. Care staff can struggle to provide care other than for basic needs such as feeding, toileting and skin care. Solution. An ethically sound solution which advances beyond the science, providing both care ‘in-the moment’ (using Namaste Care) and planning for future care needs (using the Family Carer Decision Support ‘ComfortCare’ approach). We call this the In-Touch intervention. Plan. To deliver a cross-country cluster randomised controlled trial of the InTouch intervention in 56 nursing care homes across 7 countries to determine its effect on comfort, social engagement and quality of life. This is supported by 9 work packages ensuring that: the intervention is robustly planned and contextualised for different country settings; there is understanding of how it is delivered, and what people experience and ethically value about the intervention; the cost-effectiveness is understood; we have effective plans to transfer knowledge about this intervention if it is successful. Impact. This intervention couldherald a major change in the way that care for people with advanced dementia, in the palliative phase of their illness, is provided across Europe. People with advanced dementia should have better quality of life as they approach death, improved engagement and reduced social isolation. Care staff will have an ethically sound and evidence-based intervention that is cost-effective to implement, with family members more involved in, and knowledgeable about, comfort care and future care plans.