一项干预措施,以增加晚期癌症老年人中提前护理计划:随机临床试验
Angelo E Volandes1,2,3,4, Yuchiao Chang3, Joshua R Lakin5,6,7
1Department of Medicine, Dartmouth Health, Lebanon, New Hampshire.
JAMA network open
|May 9, 2025
概括
综合干预显著增加了晚期癌症老年人的预先护理计划 (ACP) 文件. 这种方法通过确保治疗与患者价值观保持一致来增强以患者为中心的护理.
科学领域:
- 老年瘤学 老年瘤学
- 抚慰性护理是一种缓解性护理.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 许多患有晚期癌症的老年人没有沟通护理偏好,冒着错误治疗的风险.
- 需要可扩展的干预措施来改善护理目标沟通和预先护理计划 (ACP) 文档.
研究的目的:
- 评估患者和临床医生的联合干预在增加大型医疗保健系统中ACP文件的有效性.
- 评估视频决策辅助工具和沟通培训对ACP成交率的影响.
主要方法:
- 在3个美国医疗保健系统中进行了一项阶梯集群随机临床试验.
- 干预包括患者视频决策辅助工具和临床医生沟通培训;通常的护理作为对照.
- 用电子健康记录的自然语言处理测量了预先护理规划文件.
主要成果:
- 与通常护理组相比,干预组的非洲和非洲国家/地区文档比例明显高 (调整后的比例差异为6.8%).
- 在ACP国家/地区的医疗记录从通常护理阶段的20.8%增加到干预阶段的25.3%.
- 特定的ACP组件,如护理目标对话和宿舍文档,出现了显著的增长.
结论:
- 决策辅助和沟通培训的捆绑干预有效地增加了晚期癌症的老年人预先护理规划文件.
- 这种可扩展的模型为ACP文件提供了临床上有意义的改进,反映了加强了以患者为中心的护理.
- 这些发现支持采用这种干预措施,以提高老年癌症患者的护理质量.
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