基于SICP的文化适应RN-MD协作ACP：晚期癌症患者的可行性RCT
Culturally Adapted RN-MD Collaborative SICP-Based ACP: Feasibility RCT in Advanced Cancer Patients
影响因子:3.50000
分区:医学2区 / 临床神经病学2区 卫生保健与服务2区 医学：内科2区
发表日期:2024 Dec
作者:
Sayaka Takenouchi, Yu Uneno, Shigemi Matsumoto, Ai Chikada, Ryuji Uozumi, Tomoko Izawa, Sayako Ouchi, Takako Kuroda, Yu Hidaka, Hitoshi Tanimukai, Motoo Nomura, Manabu Muto, Keiko Tamura, Satoru Tsuneto, Yoshiyuki Kizawa, Tatsuya Morita, Masanori Mori
摘要
文化适应对于优化以自主权为中心的计划至关重要，例如严重疾病护理计划（SICP），尤其是对于评估家庭涉及的决策的人口，我们的目的是评估基于SICP的SICP护理人员 - 态度培训型临时性癌症的范围，以评估具有文化适应性的SICP护理人员的可行性和有效性。经过培训并与医生进行了密切合作，与干预组的患者进行了结构化讨论。基于文化的SICP ACP干预措施补充了信任，家庭参与和对患者价值观的理解。主要纳入标准包括在开始一线姑息化疗后六周内患者。主要终点是达到70％的完成率并在六个月时评估精神福祉（FACIT-SP）。次要终点包括焦虑症（GAD-7），抑郁症（PHQ-9），生活质量（QOL）（COQOLO）和ACP进度（ACP参与量表），以相同的间隔。舒适的患者（67.2％）完成了六个月的随访，随访，缺少目标完成率。在六个月的精神福祉中，最小二乘的平均变化在干预组中为3.00，在标准护理组中为-2.22（差异为5.22分； 95％置信区间，1.38-9.06； p = 0.009）。在QOL和ACP进度中观察到了类似的干预措施。尽管没有达到目标完成率，但干预组表现出增强的精神福祉，QOL和ACP的进步。我们的发现建议修订干预手册，以提高可行性并发展为以功效为中心的随机对照试验。
Abstract
Cultural adaptation is essential for optimizing programs centered around autonomy, such as the Serious Illness Care Program (SICP), especially for populations valuing family-involved decision-making.We aimed to evaluate the feasibility and efficacy of a culturally adapted SICP-based nurse-physician collaborative Advance Care Planning (ACP) intervention tailored for patients with advanced cancer who prefer family-involved decision-making.Oncology nurses, extensively trained and closely collaborating with physicians, conducted structured discussions with patients in the intervention group. The culturally adapted SICP-based ACP intervention was supplemented with trust-building, family involvement, and understanding of patient values. Primary inclusion criteria included patients within six weeks of initiating first-line palliative chemotherapy. Primary endpoints were achieving a 70% completion rate and assessing spiritual well-being (FACIT-Sp) at six months. Secondary endpoints included anxiety (GAD-7), depression (PHQ-9), quality of life (QOL) (CoQoLo), and ACP progress (ACP Engagement Scale) at the same interval.Forty-one patients (67.2%) completed the six-month follow-up, falling short of the targeted completion rate. The least-squares mean change from baseline in spiritual well-being at six months was 3.00 in the intervention group and -2.22 in the standard care group (difference, 5.22 points; 95% confidence interval, 1.38-9.06; P = 0.009). Similar superiority of the intervention was observed in QOL and ACP progress.Despite not meeting the targeted completion rate, the intervention group demonstrated enhanced spiritual well-being, QOL, and ACP progress. Our findings suggest revisions to the intervention manual to improve feasibility and to progress to an efficacy-focused randomized controlled trial.