Palliative Care for Cancer Patients in Emergency Wards

描述(由申请人提供)：在28,777名65岁或以上因肺癌、乳腺癌或胃肠道癌症在一年内死亡的患者中，9%的患者在生命的最后一个月曾去过一次或多次急诊科(ED)。许多癌症患者在临终前很久也会因癌症相关问题去急诊科就诊。在1997至2000年间，美国有210万人次因癌症前往急症室就诊。去急诊室就诊的癌症患者的症状负担很高，平均而言，在常见症状严重程度量表上，他们的症状负担超过了中间值。急诊室是癌症患者在症状或疾病急性加重时的避难所。对于那些少数族裔身份的人来说尤其如此。然而，急诊医学(EM)临床医生只接受过最低限度的姑息治疗培训。癌症患者的护理目标在急诊科就诊期间经常被不必要地重新定向，症状仍然不必要地不受控制。 因此，与医学研究所和国家癌症政策委员会呼吁整合癌症和其他疾病患者的姑息治疗相一致，我们将创建：1.课程驱动的、培训培训者的紧急肿瘤学姑息治疗教育计划，以及2.通过将其与与课程学习目标相联系的临床实践提醒相结合，在两个战略地点扩大其影响。 我们将评估该计划对态度、知识和技能以及传播的影响。对于第二部分，我们还将评估其对临床行为和患者相关临床结果的影响。 该计划将仿照高影响力的临终关怀教育(EPEC)项目，并将被称为EPEC-EM项目。传播将通过与EM专科协会合作，创建65名医生和65名护士EPEC-EM培训师来进行。培训师将通过精挑细选的申请从EM驻留项目主任和他们的项目护士那里招聘。然后，培训员将教授他们自己部门的同事和机构以外的其他人，以接触到大约9,795名最终用户。 然后，我们将在临床提醒的同时提供EPEC-EM教育，创建一个全面的干预措施，覆盖西北纪念医院和埃默里的克劳福德·朗纪念医院的急救人员。这项教育+提醒干预将使用中断的时间序列设计。该项目的这一部分使我们能够扩展通常的教育评估，不仅包括临床医生的态度、知识和一些技能的改善，而且还包括临床行为和患者结果的改善。

DESCRIPTION (provided by applicant): Of 28,777 patients 65 yrs or more who died within a year of a diagnosis of lung, breast, or gastrointestinal cancer, >9% had one or more Emergency Department (ED) visits in the last month of life. Many cancer patients also have an ED visit for a cancer-related issue long before their final days. There were 2.1 million cancer-related visits to the ED in the United States between 1997 and 2000. Cancer patients who visit the ED have a high symptom burden, with, on average, over the midway mark on common symptom severity scales. ED's are a refuge for cancer patients in the event of acute exacerbation of symptoms or illness. This is especially so for those of minority status. However, emergency medicine (EM) clinicians have minimal palliative care training. Cancer patients' care goals are often needlessly redirected during an ED visit, and symptoms remain needlessly uncontrolled. Therefore, consistent with the Institute of Medicine and the National Cancer Policy Board's call for the integration of palliative care for patients with cancer and other diseases, we will create: 1. a curriculum-driven, train-the-trainer emergency oncology palliative care education program, and 2. extend its impact in two strategic sites by coupling it with clinical practice reminders linked to curriculum learning objectives. We will evaluate the program's impact on attitudes, knowledge and skills as well as dissemination. For the second part we will also evaluate its impact on clinical behaviors and patient-related clinical outcomes. The program will be modeled on the high-impact Education on Palliative & End-of-life Care (EPEC) Project, and will be called the EPEC-EM Project. Dissemination will be by creation, in partnership with EM specialty associations, of 65 physician and 65 nurse EPEC-EM Trainers. Trainers will be recruited through merit- selected application from EM residency program directors and their program nurse. Trainers will then teach colleagues from their own ED and others beyond their institution, to reach approximately 9,795 end users. We will then provide EPEC-EM education coupled with the clinical reminders, creating one comprehensive intervention to 'blanket' the EDs at the Northwestern Memorial Hospital and Emory's Crawford Long Memorial Hospital. This education+reminders intervention will use an interrupted time-series design. This portion of the project allows us to extend the usual education evaluation to include not only improvement in clinicians' attitudes, knowledge and some skills, but also in clincial behaviours and patient outcomes.