A System for Interactive Assessment and Management in Palliative Care

描述(由申请人提供)：背景：高质量的姑息治疗评估和管理的关键是获得心理测量学上健全的和与临床相关的筛查、诊断和结果评估工具，这些工具将使医疗保健提供者获得最佳的患者评估、预后、治疗选择、患者满意度和生活质量改善。我们建议使用创新的方法和技术开发一个以患者为中心、模型驱动、基于证据的系统，称为姑息治疗中的互动评估和管理系统(SIAM-PC)。目标：我们的四个不同但相关的具体目标是：1)以现有的理论框架为指导，识别和提炼姑息治疗的领域；2)根据现有的测量方法，编制多维姑息治疗题库的条目，并补充新编写的条目；3)使用项目反应理论(IRT)经验地构建姑息关怀题库；以及4)初步测试计算机化的适应性测试(CAT)平台，以在临床环境中动态管理姑息治疗评估。方法：首先，我们将在现有框架的指导下，从深入的个人访谈(n=50；20名患者、20名家庭成员和10名临床医生)和文献综述(目标1)中识别和提炼姑息治疗的关键领域。其次，我们将从现有的衡量标准中汇编与这些领域相关的项目，为未涵盖的领域编写新的项目(目标2)。第三，我们将通过收集和分析接受姑息性治疗(目标3)的患者(n=200)的数据来测试这些项目。最后，我们将在临床实践中初步测试CAT系统(n=40)(目标4)。结果：在R21项目结束时，我们期望(1)姑息关怀测量的概念模型能够得到改进；(2)姑息关怀领域/条目的初始集合可以被构建；(3)显示DIF的条目可以被识别和修订；以及(4)CAT原型将演示如何在临床环境中实施该系统。姑息治疗是一个主要的公共卫生问题。文献中有重要的共识和充分的证据呼吁采取全面的、跨学科的方法来解决这一关切。这种全面的评估和护理要求很高，因为它依赖于多种信息来源，而现实生活中的护理的实用性取决于简明的信息。我们建议的研究是创建有效的方法，在患者评估和护理中将综合评估与简明信息联系起来。

DESCRIPTION (provided by applicant): Background: Essential to high-quality palliative care assessment and management is the availability of psychometrically-sound and clinically-relevant screening, diagnosis, and outcome evaluation tools that will enable healthcare providers to attain optimal patient evaluation, prognosis, treatment selection, patient satisfaction, and quality of life improvement. We propose to develop a patient-centered, model-driven, evidence-based system called the System for Interactive Assessment and Management in Palliative Care (SIAM-PC) using innovative methodologies and technologies. Aims: Our four distinct but related specific aims are to: 1) identify and refine the domains of palliative care, using existing theoretical frameworks as a guide; 2) compile the items for multidimensional palliative care item bank, drawing from existing measures and supplementing with newly written items; 3) empirically construct a palliative care item bank using item response theory (IRT); and 4) pilot test a computerized adaptive testing (CAT) platform to dynamically administer palliative care assessment in clinical settings. Methods: First, we will identify and refine the key domains of palliative care, guided by existing frameworks, from in-depth individual interviews (n=50; 20 patients, 20 family members and 10 clinicians) and literature review (Aim 1). Second, we will compile items pertinent to these domains from existing measures, writing new items for un-covered domains (Aim 2). Third, we will test these items by collecting and analyzing data from patients (n=200) receiving palliative (Aim 3). Finally, we will pilot test the CAT system (n=40) in clinical practice (Aim 4). Outcomes: At the end of this R21 project, we expect that (1) the conceptual model of palliative care measurement can be improved; (2) the initial sets of palliative care domains/items can be constructed; (3) items displaying DIF can be identified and revised; and (4) the CAT prototype will demonstrate how the system should be implemented in clinical settings. Palliative care is a major public health concern. There is significant consensus and ample evidence in the literature to call for a comprehensive, interdisciplinary approach to address this concern. This comprehensive assessment and care is demanding in that it depends upon multiple sources of information, and yet the practicalities of real-life care depend upon concise information. Our proposed study is to create valid methods to connect comprehensive assessment with concise information in patient assessment and care.