Division of Nephrology, Department of Medicine, Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA.
Division of Nephrology, Geriatric Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
J Palliat Med. 2021 Sep;24(9):1307-1313. doi: 10.1089/jpm.2020.0647. Epub 2021 Jan 19.
Patients receiving dialysis have unmet palliative care needs. Limited access to palliative care is a key barrier to its integration into routine dialysis care. To determine the feasibility and acceptability of telepalliative care in rural dialysis units. This was a single-arm pilot clinical trial. The target population was patients with kidney failure receiving outpatient dialysis in a rural U.S. state. Feasibility was measured by one-month completion rate. Acceptability was measured using an adapted telemedicine questionnaire. We recruited 39 patients with mean age 71.2 years to undergo a telepalliative care consultation while receiving dialysis. Four specialty palliative care clinicians (three physicians and one nurse practitioner) conducted the visits. The recruitment rate was 40% (39/96), scheduling rate was 100% (39/39), and one-month completion rate was 77% (30/39). Thirty-six patient participants (14 women and 22 men) completed the baseline survey. Audiovisual aspects of the visit were rated highly. More than 80% reported the visit being at least as good as an in-person visit and 41% felt the teleconsult was better. Eighty-one percent of patients felt the appointment was relevant to them, 58% felt they learned new things about their condition, and 27% reported the appointment changed the way they think about dialysis. Telepalliative care is acceptable to patients receiving dialysis and is a feasible approach to integrating palliative care in rural dialysis units. The study was registered with Clinicaltrials.gov (NCT03744117).
接受透析的患者存在未满足的姑息治疗需求。姑息治疗机会有限是将其纳入常规透析治疗的主要障碍。目的是确定远程姑息治疗在农村透析单位的可行性和可接受性。这是一项单臂试点临床试验。目标人群是在美国农村接受门诊透析治疗的肾衰竭患者。可行性通过一个月的完成率来衡量。可接受性通过使用经过改编的远程医疗问卷来衡量。我们招募了 39 名平均年龄为 71.2 岁的接受透析治疗的患者进行姑息治疗咨询。四名专业姑息治疗临床医生（三名医生和一名护士从业者）进行了访问。招募率为 40%（39/96），预约率为 100%（39/39），一个月的完成率为 77%（30/39）。36 名患者参与者（14 名女性和 22 名男性）完成了基线调查。访问的视听方面评价很高。超过 80%的人表示访问至少和面对面访问一样好，41%的人认为远程咨询更好。81%的患者认为预约与他们相关，58%的人认为他们了解了有关病情的新知识，27%的人报告预约改变了他们对透析的看法。远程姑息治疗对接受透析的患者是可以接受的，并且是在农村透析单位整合姑息治疗的可行方法。该研究在 ClinicalTrials.gov 上注册（NCT03744117）。
