Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
J Palliat Med. 2020 Dec;23(12):1631-1638. doi: 10.1089/jpm.2020.0103. Epub 2020 May 22.
Many older adults with serious illness who depend on others for care have symptoms that are difficult to manage. Supporting caregivers in symptom assessment (SA) may reduce suffering. Pilot an SA-Toolkit for caregivers to assess older adults' symptoms at home. Pilot study. English-speaking patients ≥65 years of age and their caregivers from a home-based geriatrics program in San Francisco. With multiple stakeholder input, we created a SA-Toolkit consisting of illustrations depicting symptoms, validated Faces Scale, and easy-to-use tracking system with phone numbers of family/friends/clinicians. At baseline and one week, we assessed change in patients' symptoms and caregivers' self-efficacy with SA (5-point scale) using Wilcoxon signed-rank tests. We assessed acceptability at one week. Eleven patient/caregiver dyads participated in the study. Patients were 84.7 years old (SD 5.7), 81.8% women, 27.3% non-white. From baseline to one week, mean number of symptoms decreased (3.7 [1.5] to 2.6 [1.8], = 0.03). Specifically, patients with pain decreased from 63.6% to 36.4%, anxiety 54.6% to 18.2%, depression 45.5% to 27.3%, and loneliness 36.4% to 18.2%. Caregiver self-efficacy increased (4.6 [0.3] to 4.8 [0.3], = 0.09). Patients found the symptom illustrations easy to use (8.7 on 10-point scale), but the Faces Scale less so (7.3/10) because it provided "too many choices." Caregivers liked the SA-Toolkit because it was easy to use; nearly all (10/11, 90%) would recommend it to others. The SA-Toolkit resulted in decreased symptom burden among patients and higher caregiver self-efficacy in SA. The SA-Toolkit is acceptable and may help reduce suffering in frail, older patients.
许多依赖他人照顾的患有重病的老年患者都有难以控制的症状。支持护理人员进行症状评估（SA）可能会减轻痛苦。 为护理人员试点一款用于在家中评估老年人症状的 SA 工具包。 试点研究。 旧金山家庭老年病学项目中的英语患者≥65 岁及其护理人员。 我们在多方利益相关者的参与下，创建了一个 SA 工具包，其中包括描绘症状的插图、经过验证的 Faces 量表以及易于使用的跟踪系统，其中包括家人/朋友/临床医生的电话号码。在基线和一周时，我们使用 Wilcoxon 符号秩检验评估了患者症状和护理人员 SA 自我效能感（5 分制）的变化。我们在一周时评估了可接受性。 11 对患者/护理人员参与了这项研究。患者年龄为 84.7 岁（标准差 5.7），81.8%为女性，27.3%为非白人。从基线到一周，症状的平均数量减少（3.7 [1.5] 至 2.6 [1.8]，= 0.03）。具体而言，患有疼痛的患者从 63.6%降至 36.4%，焦虑从 54.6%降至 18.2%，抑郁从 45.5%降至 27.3%，孤独从 36.4%降至 18.2%。护理人员的自我效能感增加（4.6 [0.3] 至 4.8 [0.3]，= 0.09）。患者发现症状插图易于使用（10 分制的 8.7 分），但 Faces 量表的得分较低（7.3/10），因为它提供了“太多选择”。护理人员喜欢 SA 工具包，因为它易于使用；几乎所有人（11 人中有 10 人，90%）都会将其推荐给他人。 SA 工具包使患者的症状负担减轻，护理人员在 SA 方面的自我效能感提高。SA 工具包是可以接受的，可能有助于减轻体弱老年人的痛苦。
