提高早期综合姑息肿瘤学护理的准备度：EMPOWER 2 干预措施的制定和初步评估。
Increasing Readiness for Early Integrated Palliative Oncology Care: Development and Initial Evaluation of the EMPOWER 2 Intervention.
机构信息
Tulane University, New Orleans, Louisiana, USA.
Tulane University, New Orleans, Louisiana, USA; University Medical Center New Orleans, New Orleans, Louisiana, USA.
出版信息
J Pain Symptom Manage. 2021 Nov;62(5):987-996. doi: 10.1016/j.jpainsymman.2021.03.027. Epub 2021 Apr 20.
CONTEXT
Early integrated palliative care improves quality of life, but palliative care programs are underutilized. Psychoeducational interventions explaining palliative care may increase patients' readiness for palliative care.
OBJECTIVES
To 1) collaborate with stakeholders to develop the EMPOWER 2 intervention explaining palliative care, 2) examine acceptability, 3) evaluate feasibility and preliminary efficacy.
METHODS
The research was conducted at a North American cancer center and involved 21 stakeholders and 10 patient-participants. Investigators and stakeholders iteratively developed the intervention. Stakeholders rated acceptability of the final intervention. Investigators implemented a pre-post trial to examine the feasibility of recruiting 10 patients with metastatic cancer within one month and with a ≥50% consent rate. Preliminary efficacy outcomes were changes in palliative care knowledge and attitudes.
RESULTS
Using feedback from four stakeholder meetings, we developed a multimedia intervention tailored to three levels of health-literacy. The intervention provides knowledge and reassurance about the purpose and nature of palliative care, addressing cognitive and emotional barriers to utilization. Stakeholders rated the intervention and design process highly acceptable (3.78/4.00). The pilot met a priori feasibility criteria (10 patients enrolled in 14 days; 83.3% consent rate). The intervention increased palliative care knowledge by 83.1% and improved attitudes by 18.9 points on a 0 to 51 scale (Ps < 0.00001).
CONCLUSIONS
This formative research outlines the development of a psychoeducational intervention about palliative care. The intervention is acceptable, feasible, and demonstrated promising pilot test results. This study will guide clinical teams in improving patients' readiness for palliative care and inform the forthcoming EMPOWER 3 randomized clinical trial.
背景
早期综合姑息治疗可提高生活质量，但姑息治疗方案的利用率较低。解释姑息治疗的心理教育干预措施可能会增加患者对姑息治疗的准备程度。
目的
1）与利益相关者合作开发解释姑息治疗的 EMPOWER 2 干预措施，2）评估可接受性，3）评估可行性和初步疗效。
方法
该研究在北美一家癌症中心进行，涉及 21 名利益相关者和 10 名患者参与者。研究人员和利益相关者对干预措施进行了迭代开发。利益相关者对最终干预措施的可接受性进行了评估。研究人员实施了一项预-后试验，以检验在一个月内招募 10 名转移性癌症患者并获得≥50%同意率的可行性。初步疗效结果为姑息治疗知识和态度的变化。
结果
利用来自四次利益相关者会议的反馈，我们开发了一种针对三种健康素养水平的多媒体干预措施。该干预措施提供了关于姑息治疗的目的和性质的知识和保证，解决了利用姑息治疗的认知和情感障碍。利益相关者对干预措施和设计过程的评价非常高（3.78/4.00）。该试验符合预先设定的可行性标准（14 天内招募了 10 名患者；同意率为 83.3%）。干预措施使姑息治疗知识增加了 83.1%，在 0 到 51 分的量表上态度提高了 18.9 分（P < 0.00001）。
结论
这项形成性研究概述了姑息治疗心理教育干预措施的开发。该干预措施是可接受的、可行的，并在初步试验中显示出有希望的结果。这项研究将指导临床团队提高患者对姑息治疗的准备程度，并为即将进行的 EMPOWER 3 随机临床试验提供信息。
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