Assessing and Treating Symptoms of Dying ICU Patients

描述(由申请人提供)：这项前瞻性描述性研究的目的是研究重症监护病房(ICU)高死亡风险患者的症状经历和这些症状的药物处理。这项研究的具体目的是考察ICU高危死亡患者及其家属、ICU护士和医生的观点，以便：(1)确定患者在ICU时间内的症状特征(即患病率、强度、频率和痛苦)；(2)确定患者、家庭成员、护士和医生对患者症状特征的一致程度；(3)检查某些因素[例如，年龄、性别、种族、疾病敏锐度、护患人员比例、医院地点和“不复苏”(DNR)状态]与症状特征的关联；(4)评估某些症状(例如，疼痛、焦虑、呼吸急促、躁动和困惑)的药理学症状管理实践。研究样本将是250名讲英语、西班牙语和中文的高死亡风险ICU患者及其家属、ICU护士和ICU医生，他们将成为代理告密者。患者和告密者将在患者入住ICU的七天内使用10项症状检查表对患者的症状特征进行评级。人口统计、用药和诊断数据将通过病历审查获得。将根据APACHE II计算患者疾病敏锐度级别，并记录护士与患者的人员配置比例、医院地点和患者的DNR状态。混合效应模型将用于分析ICU患者的症状特征，并根据不同的信息者群体进行症状特征的比较。混合效应模型将检验潜在的解释变量(年龄、性别、种族、疾病敏锐度、护士与患者的人员比例、医院地点和DNR状态)和患者症状特征之间的关系。将使用回归分析来检验特定因素对药理学症状管理实践的影响。 这项研究将为在ICU中死亡的高风险患者所经历的症状提供独特和全面的了解。结果还将提供生成和测试有关适当症状评估和管理干预措施的假设所需的经验数据。

DESCRIPTION (provided by applicant): The purpose of this prospective, descriptive study is to examine the symptom experiences of Intensive Care Unit (ICU) patients at high risk of dying and the pharmacologic management of those symptoms. The study's specific aims are to examine the perspectives of ICU patients at high risk of dying as well as family members, ICU nurses, and physicians in order to: (1) determine patient symptom characteristics (i.e., prevalence, intensity, frequency, and distress) across time in ICU; (2) determine level of agreement regarding patient symptom characteristics among patients, family members, nurses, and physicians; (3) examine the association of certain factors [e.g., age, gender, ethnicity, illness acuity, nurse-patient staffing ratios, hospital site, and "do-not-resuscitate" (DNR) status] with symptom characteristics; (4) evaluate pharmacologic symptom management practices for certain symptoms (e.g., pain, anxiety, shortness of breath, restlessness, and confusion). The study sample will be 250 English-, Spanish-, and Chinese-speaking ICU patients at high risk of dying as well as their family members, ICU nurses, and ICU physicians who will be proxy informants. Patients and informants will rate patient symptom characteristics using a 10-item symptom checklist on seven days of the patient's ICU stay. Demographic, medication, and diagnostic data will be obtained through patient chart reviews. Patient illness acuity levels will be calculated per APACHE II, and nurse-patient staffing ratios, hospital site, and patient's DNR status will be recorded. Mixed-effects models will be used to analyze patient symptom characteristics across time in ICU and to make comparisons of symptom characteristics according to the different groups of informants. The mixed effects models will examine associations among potential explanatory variables (age, gender, ethnicity, illness acuity, nurse-patient staffing ratios, hospital site, and DNR status) and patient symptom characteristics. Regression analyses will be used to examine the influence of specific factors on pharmacologic symptom management practices. The study will provide a unique and comprehensive understanding of symptoms experienced by patients at high risk of dying in ICUs. Results will also contribute empirical data needed to generate and test hypotheses concerning appropriate symptom assessment and management interventions.