来自急诊姑息治疗准入（EMPallA）的数据：一项比较专科门诊与电话姑息治疗对因急症就诊的老年晚期疾病患者的有效性的随机对照试验。
Data from emergency medicine palliative care access (EMPallA): a randomized controlled trial comparing the effectiveness of specialty outpatient versus telephonic palliative care of older adults with advanced illness presenting to the emergency department.
机构信息
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York University Langone Health, 227 E 30th Street, First Floor, New York, NY, 10016, USA.
出版信息
BMC Emerg Med. 2021 Jul 12;21(1):83. doi: 10.1186/s12873-021-00478-4.
BACKGROUND
The Emergency Medicine Palliative Care Access (EMPallA) trial is a large, multicenter, parallel, two-arm randomized controlled trial in emergency department (ED) patients comparing two models of palliative care: nurse-led telephonic case management and specialty, outpatient palliative care. This report aims to: 1) report baseline demographic and quality of life (QOL) data for the EMPallA cohort, 2) identify the association between illness type and baseline QOL while controlling for other factors, and 3) explore baseline relationships between illness type, symptom burden, and loneliness.
METHODS
Patients aged 50+ years with advanced cancer (metastatic solid tumor) or end-stage organ failure (New York Heart Association Class III or IV heart failure, end stage renal disease with glomerular filtration rate < 15 mL/min/m, or Global Initiative for Chronic Obstructive Lung Disease Stage III, IV, or oxygen-dependent chronic obstructive pulmonary disease defined as FEV < 50%) are eligible for enrollment. Baseline data includes self-reported demographics, QOL measured by the Functional Assessment of Cancer Therapy-General (FACT-G), loneliness measured by the Three-Item UCLA Loneliness Scale, and symptom burden measured by the Edmonton Revised Symptom Assessment Scale. Descriptive statistics were used to analyze demographic variables, a linear regression model measured the importance of illness type in predicting QOL, and chi-square tests of independence were used to quantify relationships between illness type, symptom burden, and loneliness.
RESULTS
Between April 2018 and April 3, 2020, 500 patients were enrolled. On average, end-stage organ failure patients had lower QOL as measured by the FACT-G scale than cancer patients with an estimated difference of 9.6 points (95% CI: 5.9, 13.3), and patients with multiple conditions had a further reduction of 7.4 points (95% CI: 2.4, 12.5), when adjusting for age, education level, race, sex, immigrant status, presence of a caregiver, and hospital setting. Symptom burden and loneliness were greater in end-stage organ failure than in cancer.
CONCLUSIONS
The EMPallA trial is enrolling a diverse sample of ED patients. Differences by illness type in QOL, symptom burden, and loneliness demonstrate how distinct disease trajectories manifest in the ED.
TRIAL REGISTRATION
Clinicaltrials.gov identifier: NCT03325985 . Registered October 30, 2017.
背景
急诊医学姑息治疗准入（EMPallA）试验是一项大型的、多中心的、平行的、双臂随机对照试验，在急诊科（ED）患者中比较了两种姑息治疗模式：护士主导的电话病例管理和专科门诊姑息治疗。本报告旨在：1）报告 EMPallA 队列的基线人口统计学和生活质量（QOL）数据，2）在控制其他因素的情况下，确定疾病类型与基线 QOL 之间的关联，3）探索疾病类型、症状负担和孤独感之间的基线关系。
方法
年龄在 50 岁以上的晚期癌症（转移性实体瘤）或终末期器官衰竭（纽约心脏协会 III 或 IV 级心力衰竭、肾小球滤过率<15mL/min/m 的终末期肾病或慢性阻塞性肺疾病全球倡议 III、IV 期或需要吸氧的慢性阻塞性肺病，定义为 FEV<50%）的患者有资格入组。基线数据包括自我报告的人口统计学信息、由癌症治疗功能评估一般量表（FACT-G）测量的生活质量、由三项目 UCLA 孤独量表测量的孤独感，以及由埃德蒙顿修订症状评估量表测量的症状负担。使用描述性统计分析人口统计学变量，线性回归模型测量疾病类型对生活质量的重要性，卡方检验用于量化疾病类型、症状负担和孤独感之间的关系。
结果
在 2018 年 4 月至 2020 年 4 月 3 日期间，共纳入了 500 名患者。平均而言，与癌症患者相比，终末期器官衰竭患者的生活质量（用 FACT-G 量表测量）更低，估计差异为 9.6 分（95%CI：5.9,13.3），而患有多种疾病的患者进一步降低了 7.4 分（95%CI：2.4,12.5），调整年龄、教育水平、种族、性别、移民身份、是否有照顾者以及医院环境后。与癌症相比，终末期器官衰竭患者的症状负担和孤独感更大。
结论
EMPallA 试验正在招募一个多样化的急诊科患者样本。疾病类型在生活质量、症状负担和孤独感方面的差异表明，不同的疾病轨迹在急诊科的表现是不同的。
试验注册
Clinicaltrials.gov 标识符：NCT03325985。于 2017 年 10 月 30 日注册。
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