Palliative Care for Cancer Patients in Emergency Wards

描述（由申请人提供）：在28，777名65岁或以上的患者中，在诊断为肺癌、乳腺癌或胃肠癌后一年内死亡，>9%的患者在生命的最后一个月内有一次或多次急诊（艾德）就诊。许多癌症患者在生命的最后几天之前，也会因为癌症相关的问题去艾德就诊。1997年至2000年，美国艾德医院有210万与癌症有关的就诊。到艾德就诊的癌症患者有很高的症状负担，平均来说，在常见症状严重程度量表上超过了中间标记。艾德是癌症患者在症状或疾病急性加重时的避难所。对于少数群体来说，情况尤其如此。然而，急诊医学（EM）临床医生有最低限度的姑息治疗培训。在艾德就诊期间，癌症患者的护理目标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关于癌症和其他疾病患者姑息治疗整合的呼吁相一致，我们将创建：1。一个由医生驱动的，培训教练的紧急肿瘤姑息治疗教育计划，和2。通过将其与与课程学习目标相关的临床实践提醒相结合，扩大其在两个战略地点的影响。 我们将评估该方案对态度、知识和技能以及传播的影响。在第二部分中，我们还将评估其对临床行为和患者相关临床结局的影响。 该计划将模仿高影响力的姑息教育和临终关怀（EPEC）项目，并将被称为EPEC-EM项目。传播将通过与EM专业协会合作，创建65名医生和65名护士EPEC-EM培训师。培训师将通过择优申请从EM住院医师项目主任及其项目护士中招募。然后，培训师将教授他们自己的艾德和其他机构的同事，以达到约9，795个最终用户。 然后，我们将提供EPEC-EM教育加上临床提醒，创造一个全面的干预措施，以“毯子”在西北纪念医院和埃默里的克劳福德长纪念医院的ED。这种教育+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。

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.