Kane Pauline M, Daveson Barbara A, Ryan Karen, Ellis-Smith Clare I, Mahon Niall G, McAdam Brendan, McQuilllan Regina, Tracey Cecelia, Howley Christine, O'Gara Geraldine, Raleigh Caroline, Higginson Irene J, Koffman Jonathan, Murtagh Fliss E M
Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.
Palliative Care, St. Francis Hospice and Mater Misericordiae University Hospital, Dublin, Ireland.
BMJ Support Palliat Care. 2017 Dec;7(4):470-479. doi: 10.1136/bmjspcare-2017-001355. Epub 2017 Sep 1.
Patients with chronic heart failure (CHF) have symptoms and concerns which are inadequately addressed. Patient-reported outcome measures (PROMs) can potentially improve the identification and management of advanced symptoms and palliative concerns. However, these have not been used in CHF.
To examine the feasibility and acceptability of using a PROM-the Integrated Palliative care Outcome Scale (IPOS)-together with heart failure nurse education and training to improve the identification and management of symptoms and concerns among patients with CHF.
A parallel, mixed methods design with an embedded qualitative component was used to examine the feasibility of recruitment, retention, intervention adherence/compliance and follow-up assessment completion (symptom burden, quality of life, psychological well-being). Patient and nurse qualitative semistructured interviews explored intervention and study design feasibility and its acceptability.
Conversion to consent was 46.9% (372 screened, 81 approached, 38 recruited). 66% of patient participants completed the IPOS; 6% of IPOS questionnaire items were missing (non-response). Over two-thirds (65.6%) of these missing items related to three patients. No item was consistently missing; appetite was the most frequent missing item (1.4%). 92% of participants who completed the IPOS completed all follow-up assessments (1-2 days, 1-2 weeks and 4-6 weeks post-IPOS completion) with no missing data. The a priori feasibility objectives were met. Patients and nurses reported the intervention and study design feasible and acceptable.
A palliative-specific PROM-based intervention is feasible and acceptable to both patients with CHF and nurses in nurse-led disease management clinics for the purposes of both clinical care and research.
慢性心力衰竭（CHF）患者的症状和担忧未得到充分解决。患者报告结局测量（PROMs）有可能改善对晚期症状和姑息治疗相关问题的识别与管理。然而，这些方法尚未在CHF中使用。
研究使用患者报告结局测量工具——综合姑息治疗结局量表（IPOS），结合心力衰竭护士教育与培训，以改善CHF患者症状和问题的识别与管理的可行性和可接受性。
采用平行混合方法设计，包含嵌入式定性成分，以检验招募、留存、干预依从性/合规性以及随访评估完成情况（症状负担、生活质量、心理健康）的可行性。患者和护士的定性半结构式访谈探讨了干预措施和研究设计的可行性及其可接受性。
同意参与率为46.9%（筛查372人，接触81人，招募38人）。66%的患者参与者完成了IPOS；IPOS问卷项目中有6%缺失（未作答）。这些缺失项目中超过三分之二（65.6%）与三名患者有关。没有项目一直缺失；食欲是最常缺失的项目（1.4%）。完成IPOS的参与者中有92%完成了所有随访评估（IPOS完成后1 - 2天、1 - 2周和4 - 6周），无缺失数据。预先设定的可行性目标得以实现。患者和护士报告干预措施和研究设计可行且可接受。
对于临床护理和研究而言，基于姑息治疗特定PROM的干预措施对CHF患者和护士主导的疾病管理诊所中的护士来说是可行且可接受的。
