检查早期姑息治疗干预对晚期心力衰竭患者的依从性和剂量效应。
Examining Adherence and Dose Effect of an Early Palliative Care Intervention for Advanced Heart Failure Patients.
机构信息
School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA.
出版信息
J Pain Symptom Manage. 2021 Sep;62(3):471-481. doi: 10.1016/j.jpainsymman.2021.01.136. Epub 2021 Feb 5.
CONTEXT
Research priority guidelines highlight the need for examining the "dose" components of palliative care (PC) interventions, such as intervention adherence and completion rates, that contribute to optimal outcomes.
OBJECTIVES
Examine the "dose" effect of PC intervention completion vs. noncompletion on quality of life (QoL) and healthcare use in patients with advanced heart failure (HF) over 32 weeks.
METHODS
Secondary analysis of the ENABLE CHF-PC intervention trial for patients with New York Heart Association (NYHA) Class III/IV HF. "Completers" defined as completing a single, in-person outpatient palliative care consultation (OPCC) plus 6 weekly, PC nurse coach-led telehealth sessions. "Non-completers" were defined as either not attending the OPCC or completing <6 telehealth sessions. Outcome variables were QoL and healthcare resource use (hospital days; emergency department visits). Mixed models were used to model dose effects for "completers" vs "noncompleters" over 32 weeks.
RESULTS
Of 208 intervention group participants, 81 (38.9%) were classified as "completers" with a mean age of 64.6 years; 72.8% were urban-dwelling; 92.5% had NYHA Class III HF. 'Completers' vs. "non-completers"" groups were well-balanced at baseline; however "noncompleters" did report higher anxiety (6.0 vs 7.0, P < 0.05, d = 0.28). Moderate, clinically significant, improved QoL differences were found at 16 weeks in "completers" vs. "non-completers" (between-group difference: -9.71 (3.18), d = 0.47, P = 0.002) but not healthcare use.
CONCLUSION
Higher intervention completion rates of an early PC intervention was associated with QoL improvements in patients with advanced HF. Future work should focus on identifying the most efficacious "dose" of intervention components and increasing adherence to them.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02505425.
背景
研究优先事项指南强调需要检查姑息治疗（PC）干预措施的“剂量”成分，例如干预的依从性和完成率，这些因素有助于获得最佳结果。
目的
在 32 周内，检查晚期心力衰竭（HF）患者 PC 干预完成与未完成对生活质量（QoL）和医疗保健使用的“剂量”效应。
方法
对纽约心脏协会（NYHA）III/IV 级 HF 患者进行的 ENABLE CHF-PC 干预试验的二次分析。“完成者”定义为完成单次门诊姑息治疗咨询（OPCC）加 6 次 PC 护士指导的远程健康会话。“未完成者”定义为未参加 OPCC 或未完成<6 次远程健康会话。结局变量为 QoL 和医疗资源使用（住院天数；急诊就诊）。使用混合模型对 32 周内“完成者”与“未完成者”的剂量效应进行建模。
结果
在 208 名干预组参与者中，81 名（38.9%）被归类为“完成者”，平均年龄为 64.6 岁；72.8%居住在城市；92.5%患有 NYHA III 级 HF。“完成者”与“未完成者”两组在基线时平衡良好；然而，“未完成者”报告的焦虑程度更高（6.0 比 7.0，P<0.05，d=0.28）。在 16 周时，“完成者”与“未完成者”之间发现了中度、具有临床意义的 QoL 差异（组间差异：-9.71（3.18），d=0.47，P=0.002），但对医疗保健的使用没有影响。
结论
早期 PC 干预措施的更高完成率与晚期 HF 患者的 QoL 改善相关。未来的工作应侧重于确定干预措施最有效的“剂量”，并提高对其的依从性。
试验注册
ClinicalTrials.gov 标识符：NCT02505425。
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