St Vincent's Hospital Melbourne, Victoria, Australia.
The University of Melbourne, Victoria, Australia.
Palliat Med. 2021 Jan;35(1):188-199. doi: 10.1177/0269216320967282. Epub 2020 Oct 31.
Family meetings facilitate the exploration of issues and goals of care however, there has been minimal research to determine the benefits and cost implications.
To determine: (1) if family caregivers of hospitalised patients referred to palliative care who receive a structured family meeting report lower psychological distress (primary outcome), fewer unmet needs, improved quality of life; feel more prepared for the caregiving role; and receive better quality of end-of-life care; (2) if outcomes vary dependant upon site of care and; (3) the cost-benefit of implementing meetings into routine practice.
Pragmatic cluster randomised trial involving palliative care patients and their primary family caregivers at three Australian hospitals. Participants completed measures upon admission (Time 1); 10 days later (Time 2) and two months after the patient died (Time 3). Regression analyses, health utilisation and process evaluation were conducted.
297 dyads recruited; control ( = 153) and intervention ( = 144). The intervention group demonstrated significantly lower psychological distress (Diff: -1.68, < 0.01) and higher preparedness (Diff: 3.48, = 0.001) at Time 2. No differences were identified based on quality of end of life care or health utilisation measures.
Family meetings may be helpful in reducing family caregiver distress and enhancing their preparedness for the caregiving role and it appears they may be conducted without increased hospital health utilisation impacts; although opportunity costs need to be considered in order to routinely offer these as a standardised intervention. Additional health economic examination is also advocated to comprehensively understand the cost-benefit implications.
Australian and New Zealand Clinical Trials Registry ACTRN12615000200583.
家庭会议有助于探讨患者的护理问题和目标，但很少有研究确定其益处和成本影响。
确定：（1）接受姑息治疗的住院患者的家庭护理人员在接受结构化家庭会议后是否报告较低的心理困扰（主要结果）、较少的未满足需求、更高的生活质量；对护理角色更有准备；并获得更好的临终关怀质量；（2）结果是否因护理地点而异；（3）将会议纳入常规实践的成本效益。
涉及澳大利亚三家医院的姑息治疗患者及其主要家庭护理人员的实用型集群随机试验。参与者在入院时（时间 1）、10 天后（时间 2）和患者死亡后两个月（时间 3）完成了测量。进行了回归分析、健康利用和过程评估。
共招募了 297 对患者和护理人员；对照组（ = 153）和干预组（ = 144）。干预组在时间 2 时表现出显著较低的心理困扰（差异：-1.68， < 0.01）和更高的准备度（差异：3.48， = 0.001）。基于临终关怀质量或健康利用措施，没有发现差异。
家庭会议可能有助于减轻家庭护理人员的痛苦，并增强他们对护理角色的准备，而且它们似乎可以在不增加医院健康利用影响的情况下进行；尽管需要考虑机会成本，以便将这些作为标准干预措施定期提供。还提倡进行额外的健康经济检查，以全面了解成本效益影响。
澳大利亚和新西兰临床试验注册中心 ACTRN12615000200583。
