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[大学生论坛]:家庭支持干预重症监护病房的随机试验

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3151204002 发表于 2018-6-21 22:57:42 | 显示全部楼层 |阅读模式
本帖最后由 3151204002 于 2018-6-21 23:06 编辑

A Randomized Trial of a Family-Support Intervention in Intensive Care Units
家庭支持干预重症监护病房的随机试验

Abstract
摘要

BACKGROUND
背景

Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients’ preferences.
病危患者经常与和护理目标相关的决定抗争,这让代患者做决定的人感到无奈。这样的决定会导致代理人的心理痛苦,并可能导致不符合患者偏好的治疗。

METHODS
方法

We conducted a stepped-wedge, cluster-randomized trial involving patients with a high risk of death and their surrogates in five intensive care units (ICUs) to compare a multicomponent family-support intervention delivered by the interprofessional ICU team with usual care. The primary outcome was the surrogates’ mean score on the Hospital Anxiety and Depression Scale (HADS) at 6 months (scores range from 0 to 42, with higher scores indicating worse symptoms). Prespecified secondary outcomes were the surrogates’ mean scores on the Impact of Event Scale (IES; scores range from 0 to 88, with higher scores indicating worse symptoms), the Quality of Communication (QOC) scale (scores range from 0 to 100, with higher scores indicating better clinician–family communication), and a modified Patient Perception of Patient Centeredness (PPPC) scale (scores range from 1 to 4, with lower scores indicating more patient- and family-centered care), as well as the mean length of ICU stay.
我们在五个重症监护病房(ICU)进行了一个阶梯式楔形、集群随机试验,包括高危死亡患者及其代理人,与由专业间ICU团队提供的多组分家庭支持干预与常规护理作比较。 初级结果是代理人在医院6个月的医院焦虑和抑郁量表(HADS)的平均得分(得分范围从0到42,得分越高表明症状越严重)。预先确定的次级结果是事件发生率的影响因素的平均得分(IES;分数范围从0到88,得分越高表明症状越重),通信质量量表(QOC)(得分范围从0到100,得分越高表明临床医生和家庭沟通质量更好,以及修改的患者感知患者中心(PPPC)量表(得分范围从1到4,较低的分数表明病人得到更多的家庭为中心的护理),以及ICU停留的平均时长。

RESULTS
结果

A total of 1420 patients were enrolled in the trial. There was no significant difference between the intervention group and the control group in the surrogates’ mean HADS score at 6 months (11.7 and 12.0, respectively; beta coefficient, −0.34; 95% confidence interval [CI], −1.67 to 0.99; P=0.61) or mean IES score (21.2 and 20.3; beta coefficient, 0.90; 95% CI, −1.66 to 3.47; P=0.49). The surrogates’ mean QOC score was better in the intervention group than in the control group (69.1 vs. 62.7; beta coefficient, 6.39; 95% CI, 2.57 to 10.20; P=0.001), as was the mean modified PPPC score (1.7 vs. 1.8; beta coefficient, −0.15; 95% CI, −0.26 to −0.04; P=0.006). The mean length of stay in the ICU was shorter in the intervention group than in the control group (6.7 days vs. 7.4 days; incidence rate ratio, 0.90; 95% CI, 0.81 to 1.00; P=0.045), a finding mediated by the shortened mean length of stay in the ICU among patients who died (4.4 days vs. 6.8 days; incidence rate ratio, 0.64; 95% CI, 0.52 to 0.78; P<0.001).
共有1420名患者参加了试验。干预组与对照组在6个月时的平均HADS评分无显著性差异(分别为11.7和12;β系数,0.34;95%置信区间[CI],1.67~0.99;P=0.61)或平均IES评分(21.2和20.3;β系数)。t,0.90;95%可信区间,1.66~3.47;P=0.49。干预组的平均QOC评分优于对照组(69.1比62.7,β系数,6.39,95% CI,2.57~10.20;P=0.001),平均PPPC评分(1.7比1.8;β系数,0.15;95% CI,0.26~0.26;P=1)。干预组ICU的平均住院时间比对照组短(6.7天vs 7.4天;发病率比为0.90;95% CI,0.81至1;P=0.045),在ICU死亡患者中缩短的平均住院日(4.4天vs 6.8天);信率0.64,95%可信区间0.5

CONCLUSIONS
结论

Among critically ill patients and their surrogates, a family-support intervention delivered by the interprofessional ICU team did not significantly affect the surrogates’ burden of psychological symptoms, but the surrogates’ ratings of the quality of communication and the patient- and family-centeredness of care were better and the length of stay in the ICU was shorter with the intervention than with usual care. (Funded by the UPMC Health System and the Greenwall Foundation; PARTNER ClinicalTrials.gov number,NCT01844492
在危重病人及其代理人中,由职业间ICU小组提供的家庭支持干预并没有显著影响代理人的心理症状负担,而是影响了代理人对通信质量和患者和家庭的评价。护理干预效果较好,ICU住院时间短于常规护理。(由UPMC卫生系统格林沃基金会资助; 编号;NCT01844492

来源  https://www.nejm.org/doi/full/10 ... query=featured_home
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