Department of Palliative Care and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
London School of Hygiene & Tropical Medicine, London, UK.
Lancet HIV. 2015 Aug;2(8):e328-34. doi: 10.1016/S2352-3018(15)00111-3. Epub 2015 Jun 15.
People with HIV accessing antiretroviral therapy (ART) have persistent physical, psychological, social, and spiritual problems, which are associated with poor quality of life and treatment outcomes. We assessed the effectiveness of a nurse-led palliative care intervention on patient-reported outcomes.
We did this randomised controlled trial at a clinic in Kenya for adults with HIV, established on ART, and reporting moderate-to-severe pain or symptoms. We randomly assigned participants (1:1) either to a palliative care intervention (including assessments of physical, emotional, and spiritual wellbeing and quality of life) given six times over 4 months, or to usual care. Participants and investigators were not masked to allocation. The primary outcome was pain (scored on the African Palliative Care Association's African Palliative Outcome Scale). This trial is registered with ClinicalTrials.gov, number NCT01608802.
We screened 2070 patients, of whom we enrolled 120: 60 allocated to each group. In the control group, median pain score improved from 1·0 (IQR 0·0-2·0) at baseline to 5·0 (3·0-5·0) at 4 months; in the intervention group, it improved from 1·0 (0·0-2·0) at baseline to 4·5 (3·0-5·0) at 4 months. Compared with standard care, the intervention had no significant effect on pain (coefficient -0·01, 95% CI -0·36 to 0·34, p=0·95).
A nurse-led palliative care intervention was not effective in reducing pain. However, person-centred assessment and care delivered by staff who have received additional training had positive effects on self-reported mental health related quality of life and psychosocial wellbeing.
Diana Princess of Wales Memorial Fund.
接受抗逆转录病毒疗法（ART）的艾滋病毒感染者仍存在身体、心理、社会和精神方面的问题，这些问题与生活质量差和治疗结果不佳有关。我们评估了护士主导的姑息治疗干预对患者报告结果的有效性。
我们在肯尼亚的一家诊所开展了这项随机对照试验，纳入了已接受 ART 治疗且报告中度至重度疼痛或症状的艾滋病毒感染者。我们将参与者（1:1）随机分配至姑息治疗干预组（包括对身体、情绪和精神健康以及生活质量的评估）或常规护理组。参与者和研究人员对分组不知情。主要结局是疼痛（采用非洲姑息治疗协会的非洲姑息治疗结局量表评分）。这项试验在 ClinicalTrials.gov 注册，编号为 NCT01608802。
我们对 2070 名患者进行了筛查，纳入了 120 名患者：每组 60 名。在对照组，疼痛评分中位数从基线时的 1.0（0.0-2.0）改善至 4 个月时的 5.0（3.0-5.0）；在干预组，从基线时的 1.0（0.0-2.0）改善至 4 个月时的 4.5（3.0-5.0）。与标准护理相比，干预对疼痛没有显著影响（差值 -0.01，95%CI -0.36 至 0.34，p=0.95）。
护士主导的姑息治疗干预不能有效减轻疼痛。然而，接受过额外培训的工作人员提供的以患者为中心的评估和护理对自我报告的心理健康相关生活质量和心理社会健康有积极影响。
戴安娜王妃纪念基金会。
