School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia V2N 4Z9 Canada.
School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON N2L 6P4 Canada.
BMC Palliat Care. 2014 Dec 15;13(1):58. doi: 10.1186/1472-684X-13-58. eCollection 2014.
The interRAI Palliative Care (interRAI PC) assessment instrument provides a standardized, comprehensive means to identify person-specific need and supports clinicians to address important factors such as aspects of function, health, and social support. The interRAI Clinical Assessment Protocols (CAPs) inform clinicians of priority issues requiring further investigation where specific intervention may be warranted and equip clinicians with evidence to better inform development of a person-specific plan of care. This is the first study to describe the interRAI PC CAP development process and provide an overview of distributional properties of the eight interRAI PC CAPs among community dwelling adults receiving palliative home care services.
Secondary data analysis used interRAI PC assessments (N = 6,769) collected as part of regular clinical practice at baseline (N = 6,769) and follow-up (N = 1,000). Clients across six regional jurisdictions in Ontario, Canada, assessed to receive palliative homecare services between 2006 and 2011 were included (mean age 70.0 years; ±13.4 years). Descriptive analyses focused on the eight interRAI PC CAPs: Fatigue, Sleep Disturbance, Nutrition, Pressure Ulcers, Pain, Dyspnea, Mood Disturbance and Delirium.
The majority of clients triggered at least one CAP while two thirds triggered two or more. Triggering rates ranged from 74% for the Fatigue CAP to less than 15% for the Delirium and Pressure Ulcers CAPs. The hierarchical CAP triggering structure suggested Fatigue and Dyspnea CAPs were persistent issues prevalent among the majority of clients while Delirium and Pressure Ulcers CAPs rarely trigger in isolation and most often trigger later in the illness trajectory.
When any of the eight interRAI PC CAPs are triggered, clinicians should take notice. CAPs triggered at high rates such as fatigue, dyspnea, and pain warrant increased attention for the majority of clients. Consideration of triggered CAPs provide evidence to inform a collaborative decision making process on whether or not issues raised by the CAPs should be addressed in the plan of care. Integrating evidence from the interRAI PC CAPs into the clinical decision making process support care planning to address client strengths, preferences and needs with greater acuity.
interRAI 姑息治疗（interRAI PC）评估工具提供了一种标准化、全面的方法来确定特定人群的需求，并支持临床医生解决重要因素，如功能、健康和社会支持方面的问题。interRAI 临床评估方案（CAPs）告知临床医生需要进一步调查的优先问题，在这些问题中，可能需要特定的干预措施，并为临床医生提供证据，以便更好地为特定人群制定护理计划。这是第一项描述 interRAI PC CAP 开发过程的研究，并提供了在接受姑息治疗家庭护理服务的社区居住成年人中，八个 interRAI PC CAP 的分布特征概述。
使用 interRAI PC 评估（N=6769）进行二次数据分析，这些评估是作为 2006 年至 2011 年期间常规临床实践的一部分在基线（N=6769）和随访（N=1000）时收集的。纳入了安大略省六个地区司法管辖区的接受姑息治疗家庭护理服务评估的客户（平均年龄 70.0 岁；±13.4 岁）。描述性分析集中在八个 interRAI PC CAP 上：疲劳、睡眠障碍、营养、压疮、疼痛、呼吸困难、情绪障碍和谵妄。
大多数客户至少触发了一个 CAP，而三分之二的客户触发了两个或更多。触发率从疲劳 CAP 的 74%到谵妄和压疮 CAP 的不到 15%不等。CAP 触发的层次结构表明，疲劳和呼吸困难 CAP 是大多数客户普遍存在的持续问题，而谵妄和压疮 CAP 很少单独触发，大多数情况下在疾病轨迹的后期触发。
当触发任何一个 interRAI PC CAP 时，临床医生都应该注意。疲劳、呼吸困难和疼痛等触发率较高的 CAP 需要引起大多数客户的更多关注。考虑触发的 CAP 可以为是否应该在护理计划中解决 CAP 提出的问题提供证据，从而为协作决策过程提供依据。将 interRAI PC CAP 的证据纳入临床决策过程，支持更敏锐地解决客户的优势、偏好和需求，以制定护理计划。
