Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal.
Palliat Med. 2024 Sep;38(8):842-852. doi: 10.1177/02692163231219682. Epub 2024 Jan 16.
Evidence suggests that involving General Practitioners in the care of patients with palliative care needs may improve patient outcomes.
To evaluate whether a two-tiered intervention involving training in palliative care and a new consultation model in primary care for patients with palliative care needs is feasible and could reduce patients' symptom burden.
Before-after study including an internal pilot.
SETTING/PARTICIPANTS: Nine general practitioners working in a health region in Portugal and 53 patients with palliative care needs from their patient lists were recruited. General Practitioners received training in palliative care and used a new primary palliative care consultation model, with medical consultations every 3 weeks for 12 weeks. The primary outcome was physical symptom burden, self-reported using the Integrated Palliative care Outcome Scale (IPOS) patient version (min.0-max.1000). Secondary outcomes included emotional symptoms (min.0-max.400) and communication/practical issues (min.0-max.300).
Of the 35/53 patients completed the 12-week intervention (mean age 72.53 years, SD = 13.45; 54.7% female). All had advanced disease: one third had cancer ( = 13), one third had congestive heart failure ( = 12); others had chronic kidney disease and chronic obstructive pulmonary disease. After the 12 weeks of intervention, there was a reduction in physical symptom burden [mean difference from baseline of 71.42 (95%CI 37.01-105.85) with a medium-large effect size (0.71], and in emotional symptom burden [mean difference 42.86 (95%CI 16.14-69.58), with a medium effect size (0.55)]. No difference was found for communication/practical issues.
Our intervention can be effective in reducing patients' physical and emotional symptoms.
ClinicalTrials.gov ID - NCT05244590. Registration: 14th February 2022.
有证据表明，让全科医生参与有姑息治疗需求的患者的护理工作可能会改善患者的结局。
评估一种涉及姑息治疗培训和初级保健中新咨询模式的两层干预措施对于有姑息治疗需求的患者是否可行，并能减轻患者的症状负担。
包括内部试点的前后研究。
地点/参与者：9 名在葡萄牙一个卫生区域工作的全科医生和他们患者名单上的 53 名有姑息治疗需求的患者被招募。全科医生接受了姑息治疗培训，并使用了一种新的初级姑息治疗咨询模式，每 3 周进行一次医疗咨询，为期 12 周。主要结局是身体症状负担，使用综合姑息治疗结局量表（IPOS）患者版（最低 0 分-最高 1000 分）自评。次要结局包括情绪症状（最低 0 分-最高 400 分）和沟通/实际问题（最低 0 分-最高 300 分）。
53 名完成 12 周干预的患者中有 35 名（平均年龄 72.53 岁，标准差=13.45；54.7%为女性）。所有患者均患有晚期疾病：三分之一患有癌症（=13），三分之一患有充血性心力衰竭（=12）；其他人患有慢性肾脏病和慢性阻塞性肺疾病。干预 12 周后，身体症状负担减轻[从基线的平均差异为 71.42（95%CI 37.01-105.85），具有中等-大效应量（0.71]，情绪症状负担减轻[平均差异 42.86（95%CI 16.14-69.58），具有中等效应量（0.55]。沟通/实际问题无差异。
我们的干预措施可以有效减轻患者的身体和情绪症状。
ClinicalTrials.gov 编号-NCT05244590。注册日期：2022 年 2 月 14 日。
