Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, Bessemer Road, SdE59PJ, London, UK.
Dartington Service Design Lab, Lower Hood Barn, Dartington, Totnes, TQ9 6AB, UK.
BMC Infect Dis. 2018 Jan 10;18(1):27. doi: 10.1186/s12879-017-2900-0.
A new model of care is required to meet the changing needs of people living with HIV (PLWH), particularly in low and middle-income countries, where prevalence is highest. We evaluated a palliative care intervention for PLWH in Mombasa, Kenya. Although we found no effect on pain (primary outcome), there was a positive effect on mental health (secondary outcome) in the intervention group. To inform replication and implementation, we have determined the active ingredients of the intervention and their mechanisms of action.
We conducted a randomised controlled trial (RCT) with qualitative exit interviews in HIV clinic attenders. The intervention was delivered over 5 months, with a minimum of 7 clinical contacts. Longitudinal quantitative data on components of care received were analysed using area under the curve and logistic regression. Qualitative data were analysed using inductive and deductive thematic analysis.
Quantitative data analysis identified that intervention patients received more weak opioid, laxatives, discussion about spiritual worries, emotional support from staff for themselves and their families, time to talk about worries, discussion about future and planning ahead. Qualitative data analysis found that patients reported that having time to talk, appropriate pain medication and effective health education was of therapeutic value for their psychological well-being. Integration of mixed method findings suggest that positive effect in quantitative measures of mental health and well-being are attributable to the active ingredients of: appropriate medication, effective health education and counselling, and having time to talk in clinical encounters. Mechanisms of action include symptom relief, improved understanding of illness and treatment, and support focused on articulated concerns.
Routine care must provide opportunities and means for existing clinical staff to make routine appointments more person-centred. This approach enabled staff to identify and manage multidimensional problems and provide tailored health education and counselling.
ClinicalTrials.gov ( NCT01608802 ). Registered 12th May 2012.
需要一种新的护理模式来满足艾滋病毒感染者（PLWH）不断变化的需求，特别是在流行率最高的中低收入国家。我们评估了肯尼亚蒙巴萨的一种姑息治疗干预措施对 PLWH 的效果。尽管我们没有发现对疼痛（主要结局）有影响，但干预组的心理健康（次要结局）有积极影响。为了提供复制和实施的信息，我们确定了干预措施的有效成分及其作用机制。
我们在 HIV 门诊就诊者中进行了一项随机对照试验（RCT），并进行了定性的退出访谈。干预措施在 5 个月内实施，至少有 7 次临床接触。使用曲线下面积和逻辑回归分析接受护理的各个组成部分的纵向定量数据。使用归纳和演绎主题分析方法分析定性数据。
定量数据分析发现，干预组患者接受了更多的弱阿片类药物、泻药、关于精神忧虑的讨论、工作人员对自己和家人的情感支持、有时间谈论忧虑、讨论未来和提前计划。定性数据分析发现，患者报告说，有时间交谈、适当的止痛药物和有效的健康教育对他们的心理健康具有治疗价值。混合方法研究结果的整合表明，心理健康和幸福感的定量测量的积极效果归因于以下有效成分：适当的药物治疗、有效的健康教育和咨询，以及在临床接触中有时间交谈。作用机制包括缓解症状、提高对疾病和治疗的理解，以及侧重于表达关注的支持。
常规护理必须为现有临床工作人员提供机会和手段，使常规预约更加以患者为中心。这种方法使工作人员能够识别和处理多维度的问题，并提供量身定制的健康教育和咨询。
ClinicalTrials.gov（NCT01608802）。2012 年 5 月 12 日注册。
