Gu Jessie, Wang Peijin, Chow Shein-Chung, Dempsey Katelyn, Bermejo Santos, Swaminathan Aparna, Soskis Alyssa, Fried Julie, Kloefkorn Chad, Jones Christopher, Cox Christopher E
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
Am J Hosp Palliat Care. 2025 Jul;42(7):653-660. doi: 10.1177/10499091241275966. Epub 2024 Aug 19.
Outpatients with interstitial lung disease often experience serious symptoms, yet infrequently receive palliative care. To determine the feasibility and clinical impact of a mobile application (PCplanner) in an outpatient setting. We conducted a pilot randomized controlled trial among adults with interstitial lung disease in a single-center academic clinic. Clinical outcomes included change in Needs at the End-of-Life Screening Tool (NEST) scale between baseline and 3 months as well as frequency of advance care planning discussions and referrals to palliative care services. Observed feasibility outcomes were similar to targeted benchmarks including randomization rates (82.1% vs 80%) and retention (84.8% vs 80%). Mean NEST scores between the intervention and control group were 38.9 (SD, 18.9) vs 41.5 (SD, 20.5) at baseline, 34.6 (SD, 18.9) vs 33.6 (SD, 19.4) at 1 month after clinic visit, 40.5 (SD, 21.6) vs 35.3 (SD, 25.0) at 3 months after clinic visit. Changes in NEST scores between baseline and 3 months showed no difference in the primary outcome ( = 0.481, 95% CI [-8.45, 17.62]). Among patients with interstitial lung disease, a mobile app designed to focus patients and clinicians on palliative care principles demonstrated evidence of feasibility. Although changes in self-reported needs were similar between intervention and control groups, more patients in the intervention group updated their advance directives and code status compared to the control group. Palliative Care Planner (PCplanner) NCT05095363. https://www.clinicaltrials.gov/study/NCT05095363.
间质性肺病门诊患者常出现严重症状，但很少接受姑息治疗。为了确定移动应用程序（PCplanner）在门诊环境中的可行性和临床影响。我们在一家单中心学术诊所对成年间质性肺病患者进行了一项试点随机对照试验。临床结果包括临终筛查工具（NEST）量表在基线和3个月之间的需求变化，以及预先护理计划讨论的频率和转介至姑息治疗服务的情况。观察到的可行性结果与目标基准相似，包括随机化率（82.1%对80%）和保留率（84.8%对80%）。干预组和对照组在基线时的平均NEST评分分别为38.9（标准差，18.9）和41.5（标准差，20.5），门诊就诊后1个月分别为34.6（标准差，18.9）和33.6（标准差，19.4），门诊就诊后3个月分别为40.5（标准差，21.6）和35.3（标准差，25.0）。基线和3个月之间NEST评分的变化在主要结局方面无差异（P = 0.481，95%可信区间[-8.45, 17.62]）。在间质性肺病患者中，一款旨在让患者和临床医生关注姑息治疗原则的移动应用程序显示出可行性证据。尽管干预组和对照组在自我报告需求方面的变化相似，但与对照组相比，干预组中有更多患者更新了他们的预先指示和医疗状态代码。姑息治疗计划器（PCplanner）NCT05095363。https://www.clinicaltrials.gov/study/NCT05095363 。
