Implementation of Home-Based Palliative Care in Limited Resource Settings

项目总结/摘要 在资源匮乏的情况下，姑息治疗的使用极其有限，加剧了患者的痛苦， 限制疾病，如癌症。对于生活在农村地区的患者来说，这尤其是一个问题， 关怀更加明显。这些障碍包括与癌症中心的距离，缺乏 农村社区的医疗保健提供者，限制性的吗啡获取政策，缺乏交通工具， 治疗费用。由于这些原因，大多数生活在农村社区的患者从未接受过姑息治疗， 甚至是基本的疼痛控制认识到在资源有限的情况下迫切需要姑息治疗， 世界卫生组织发布了姑息治疗工具包，作为社区成员可以 在他们自己的社区提供姑息治疗。该工具包提供了基于证据的教育 材料，以管理身体，情感和威胁生命的疾病的实际挑战，沿着 数据收集工具，以评估和管理患者的需求。我们将开展一项务实的临床试验， 评估一项新的Pal-Care干预措施的实施情况，该干预措施将利用社区卫生工作者， 使用姑息治疗工具包促进提供基本姑息治疗。研究将于 印度加尔各答的塔塔医疗中心，他们的病人居住在24帕加纳斯地区以外的 印度加尔各答。在患者水平进行随机化后，将有一个干预组， 一名接受过姑息治疗培训的社区卫生工作者和一名对照者提供基于家庭的姑息治疗服务。 将接受标准癌症中心姑息治疗服务的群体。两个具体目标将是 在研究中评估。目的1将是评估实施以家庭为基础的姑息治疗 在RE-AIM框架领域（如覆盖范围、有效性、采用、 实施和维护）。为了评估这一目标，我们将对来自多个数据源的数据进行三角测量， 包括评估社区卫生工作者培训的事前调查， 导航员在癌症中心提供护理、会议记录和干预后采访时 利益相关者（临床团队、卫生工作者和患者/护理人员）。目标2将是评估这一成果 干预以确定其与标准对照组相比对不同患者终点的相对影响， 包括姑息治疗需求、症状负担、生活质量和护理经验。

PROJECT SUMMARY/ABSTRACT The extremely limited use of palliative care in low resource settings exacerbates suffering in patients with life- limiting illnesses such as cancer. This is particularly a problem for patients living in rural areas where barriers to care are even more pronounced. These barriers include factors such as distance from a cancer center, lack of healthcare providers in rural communities, restrictive morphine access policies, lack of transportation and treatment costs. For these reasons, most patients living in rural communities never receive palliative care or even basic pain management. In recognition of the urgent need for palliative care in limited resource settings, the World Health Organization released the Palliative Care Toolkit as a resource that community members can use to deliver palliative care in their own communities. The toolkit provides evidence-based educational materials to manage the physical, emotional and practical challenges of life-threatening illnesses, along with data collection instruments to assess and manage patient needs. We will carry out a pragmatic clinical trial to evaluate implementation of a novel Pal-Care intervention that will leverage community health workers to facilitate the delivery of basic palliative care using the Palliative Care Toolkit. The study will be conducted at the Tata Medical Center in Kolkata India, among their patients who reside in the 24 Parganas region outside of Kolkata, India. With randomization at the patient level, there will be an intervention group which will receive home-based palliative care services from a community health worker trained in palliative care and a control group which will receive standard cancer-center based palliative care services. Two specific aims will be evaluated within the study. Aim 1 will be to evaluate implementation of the home-based palliative care intervention within the context of the RE-AIM Framework domains (e.g. Reach, Effectiveness, Adoption, Implementation and Maintenance). To evaluate this aim, we will triangulate data from multiple data sources, including pre-post surveys to evaluate the community health worker training, palliative care logs completed by navigators while delivering care, meeting minutes and post-intervention interviews with cancer center stakeholders (clinical team, health workers and patients/caregivers). Aim 2 will be to evaluate outcomes of this intervention to determine its relative effects compared to a standard control group on diverse patient endpoints, including palliative care needs, symptom burden, quality of life and experience with care.