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检查重症监护室（ICU）高死亡风险患者的症状经历以及这些症状的药物管理。该研究的具体目的是检查ICU高死亡风险患者以及家庭成员，ICU护士和医生的观点，以便：（1）确定患者症状特征（即，患病率、强度、频率和痛苦）;（2）确定患者、家庭成员、护士和医生之间关于患者症状特征的一致程度;（3）检查某些因素的关联[例如，年龄、性别、种族、疾病严重性、护士-患者人员比例、医院地点和“不复苏”（DNR）状态]与症状特征;（4）评价某些症状的药理学症状管理实践（例如，疼痛、焦虑、呼吸短促、不安和意识模糊）。研究样本将是250名讲英语，西班牙语和中文的ICU高死亡风险患者以及他们的家庭成员，ICU护士和ICU医生，他们将成为代理信息提供者。患者和被调查者将在患者入住ICU的7天内使用10项症状检查表对患者症状特征进行评分。将通过患者病历审查获得人口统计学、药物和诊断数据。将根据APACHE II计算患者病情紧急程度，并记录护士-患者人员比例、医院地点和患者的DNR状态。将使用混合效应模型分析ICU中不同时间的患者症状特征，并根据不同的受试者组比较症状特征。混合效应模型将检查潜在解释变量（年龄、性别、种族、疾病严重程度、护士-患者人员比例、医院地点和DNR状态）与患者症状特征之间的关联。回归分析将用于检查特定因素对药理学症状管理实践的影响。 这项研究将提供一个独特的和全面的了解所经历的症状的患者在高风险的死亡在ICU。研究结果还将有助于产生和测试有关适当的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.