全科医生与专科姑息治疗服务机构之间及时进行病例会诊对晚期慢性病患者症状负担的影响：整群随机对照KOPAL试验的结果

Effects of timely case conferencing between general practitioners and specialist palliative care services on symptom burden in patients with advanced chronic disease: results of the cluster-randomised controlled KOPAL trial.

作者信息

Mallon Tina, Schulze Josefine, Pohontsch Nadine, Asendorf Thomas, Weber Jan, Böttcher Silke, Sekanina Uta, Schade Franziska, Schneider Nils, Dams Judith, Freitag Michael, Müller Christiane, Nauck Friedemann, Friede Tim, Scherer Martin, Marx Gabriella

机构信息

Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.

Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073, Göttingen, Germany.

出版信息

BMC Palliat Care. 2024 Dec 20;23(1):293. doi: 10.1186/s12904-024-01623-z.

DOI:10.1186/s12904-024-01623-z

PMID:39707283

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11662516/

Abstract

BACKGROUND

Patients with advanced chronic non-malignant conditions often experience significant symptom burden. Therefore, overcoming barriers to interprofessional collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams is essential to facilitate the timely integration of palliative care elements. The KOPAL trial aimed to examine the impact of case conferences between GPs and SPHC teams on symptom burden and pain in patients with advanced chronic heart failure, chronic obstructive pulmonary disease, and dementia.

METHODS

The cluster-randomised controlled trial compared a structured palliative care nurse visit followed by an interprofessional case conference to usual care. Data were collected from GPs at baseline and 48 weeks, while standardised patient interviews were conducted at baseline, 6, 12, 24, and 48 weeks.

RESULTS

We analysed 172 patients from 49 German GP practices. Both groups showed marginal improvement in symptom burden; however, no statistically significant between-group difference was found ([Formula: see text]=-0.561, 95% CI: -3.201-2.079, p = .68). Patients with dementia experienced a significant pain reduction ([Formula: see text]=2.187, 95% CI: 0.563-3.812, p = .009). Conversely, the intervention did not have a significant effect on pain severity ([Formula: see text]=-0.711, 95% CI: -1.430 - 0.008, p=.053) or pain interference ([Formula: see text]=-0.036, 95% CI:-0.797 - 0.725, p=.926) in other patient groups.

CONCLUSIONS

The intervention showed promise in the timely introduction of palliative care elements to address pain management in patients with dementia. Further studies are needed to identify and effectively address symptom burden and pain in other patient groups.

TRIAL REGISTRATION

German Clinical Trials Register: https://www.drks.de/DRKS00017795 (Registration date: 9th January 2020).

摘要

背景

患有晚期慢性非恶性疾病的患者常常承受着巨大的症状负担。因此，克服全科医生（GP）与专科姑息家庭护理（SPHC）团队之间跨专业协作的障碍，对于促进姑息治疗要素的及时整合至关重要。KOPAL试验旨在研究全科医生与专科姑息家庭护理团队之间的病例讨论会对晚期慢性心力衰竭、慢性阻塞性肺疾病和痴呆患者的症状负担及疼痛产生的影响。

方法

这项整群随机对照试验将结构化姑息护理护士访视并随后进行跨专业病例讨论会与常规护理进行了比较。在基线和48周时从全科医生处收集数据，同时在基线、6周、12周、24周和48周时进行标准化患者访谈。

结果

我们分析了来自49个德国全科医生诊所的172名患者。两组的症状负担均有轻微改善；然而，未发现组间有统计学显著差异（[公式：见正文]= -0.561，95%置信区间：-3.201 - 2.079，p = 0.68）。痴呆患者的疼痛有显著减轻（[公式：见正文]= 2.187，95%置信区间：0.563 - 3.812，p = 0.009）。相反，该干预对其他患者组的疼痛严重程度（[公式：见正文]= -0.711，95%置信区间：-1.430 - 0.008，p = 0.053）或疼痛干扰（[公式：见正文]= -0.036，95%置信区间：-0.797 - 0.725，p = 0.926）没有显著影响。