本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.24035

摘要内容如下：

重要性

许多患有慢性阻塞性肺病（COPD）、心力衰竭（HF）和间质性肺病（ILD）的患者尽管接受了常规治疗，但生活质量仍然很差。姑息治疗方法可能使这一人群在生命结束前受益。

目的

与常规护理相比，确定护士和社会工作者姑息远程护理团队对COPD、HF或ILD门诊患者生活质量的影响。

设计、设置和参与者

2016年10月27日至2020年4月2日，在2个退伍军人管理局医疗保健系统（科罗拉多州和华盛顿州），包括社区门诊诊所，进行了单盲、2组、多点随机临床试验。报告生活质量差的住院或死亡风险高的COPD、HF或ILD门诊患者参与了研究。

干预

干预措施包括与一名护士通6次电话以帮助症状管理，与一名社会工作者通6次电话以提供心理社会护理。护士和社会工作者每周会见一名研究初级保健和姑息治疗医生，并根据需要会见一名肺病学家和心脏病学家。常规护理包括为该研究编写的教育讲义，其中概述了COPD、ILD或HF的自我护理。两组患者均由其临床医生酌情决定接受护理，包括护士和社会工作者的护理，以及心脏病学、肺病学、姑息治疗和心理健康方面的专家。

主要成果和措施

主要转归是干预组和常规护理组从基线到6个月的生活质量变化差异（FACT-G评分范围0-100，评分越高表示生活质量越好，有临床意义的变化≥4分）。6个月时的次要生活质量结果包括疾病特异性健康状况（临床COPD问卷；堪萨斯城心肌病问卷-12）、抑郁（患者健康问卷-8）和焦虑（广泛性焦虑症-7）症状。

结果

在306名随机患者中（平均[SD]年龄，68.9[7.7]岁；276名男性[90.2%]，30名女性[9.8%]；245名白人[80.1%]），177名（57.8%）患有COPD，67名（21.9%）患有HF，49名（16%）同时患有COPD和HF，13名（4.2%）患有ILD。基线FACT-G评分相似（干预，52.9；日常护理，52.7）。在6个月时，两组的FACT-G完成率均为76%（干预，154例中的117例；常规护理，152例中的116例）。平均（SD）干预时间为115.1（33.4）天，平均每个患者有10.4（3.3）次干预呼叫。在干预组中，154名患者中有112名（73%）接受了随机干预。在6个月时，干预组的平均FACT-G评分提高了6.0分，常规护理组提高了1.4分（差异，4.6分[95%CI，1.8-7.4]；P=.001；标准化平均差，0.41）。干预还改善了COPD健康状况（标准化平均差，0.44；P=.04），HF健康状况（标准化平均差，0.41；P=.01），抑郁（标准化均数差，-0.50；P<.001）和焦虑（标准化平均差，-0.51；6个月时P<.001）。

结论和相关性

对于死亡风险高且生活质量差的成人COPD、HF或ILD患者，与常规护理相比，护士和社会工作者姑息远程护理团队在6个月时产生了具有临床意义的生活质量改善。

试用注册

ClinicalTrials.gov标识符：NCT02713347。

英文原文如下：

Abstracts

Importance  Many patients with chronic obstructive pulmonary disease (COPD), heart failure (HF), and interstitial lung disease (ILD) endure poor quality of life despite conventional therapy. Palliative care approaches may benefit this population prior to end of life.

Objective  Determine the effect of a nurse and social worker palliative telecare team on quality of life in outpatients with COPD, HF, or ILD compared with usual care.

Design, Setting, and Participants  Single-blind, 2-group, multisite randomized clinical trial with accrual between October 27, 2016, and April 2, 2020, in 2 Veterans Administration health care systems (Colorado and Washington), and including community-based outpatient clinics. Outpatients with COPD, HF, or ILD at high risk of hospitalization or death who reported poor quality of life participated.

Intervention  The intervention involved 6 phone calls with a nurse to help with symptom management and 6 phone calls with a social worker to provide psychosocial care. The nurse and social worker met weekly with a study primary care and palliative care physician and as needed, a pulmonologist, and cardiologist. Usual care included an educational handout developed for the study that outlined self-care for COPD, ILD, or HF. Patients in both groups received care at the discretion of their clinicians, which could include care from nurses and social workers, and specialists in cardiology, pulmonology, palliative care, and mental health.

Main Outcomes and Measures  The primary outcome was difference in change in quality of life from baseline to 6 months between the intervention and usual care groups (FACT-G score range, 0-100, with higher scores indicating better quality of life, clinically meaningful change ≥4 points). Secondary quality-of-life outcomes at 6 months included disease-specific health status (Clinical COPD Questionnaire; Kansas City Cardiomyopathy Questionnaire-12), depression (Patient Health Questionnaire-8) and anxiety (Generalized Anxiety Disorder-7) symptoms.

Results  Among 306 randomized patients (mean [SD] age, 68.9 [7.7] years; 276 male [90.2%], 30 female [9.8%]; 245 White [80.1%]), 177 (57.8%) had COPD, 67 (21.9%) HF, 49 (16%) both COPD and HF, and 13 (4.2%) ILD. Baseline FACT-G scores were similar (intervention, 52.9; usual care, 52.7). FACT-G completion was 76% (intervention, 117 of 154; usual care, 116 of 152) at 6 months for both groups. Mean (SD) length of intervention was 115.1 (33.4) days and included a mean of 10.4 (3.3) intervention calls per patient. In the intervention group, 112 of 154 (73%) patients received the intervention as randomized. At 6 months, mean FACT-G score improved 6.0 points in the intervention group and 1.4 points in the usual care group (difference, 4.6 points [95% CI, 1.8-7.4]; P = .001; standardized mean difference, 0.41). The intervention also improved COPD health status (standardized mean difference, 0.44; P = .04), HF health status (standardized mean difference, 0.41; P = .01), depression (standardized mean difference, -0.50; P < .001), and anxiety (standardized mean difference, -0.51; P < .001) at 6 months.

Conclusions and Relevance  For adults with COPD, HF, or ILD who were at high risk of death and had poor quality of life, a nurse and social worker palliative telecare team produced clinically meaningful improvements in quality of life at 6 months compared with usual care.

Trial Registration  ClinicalTrials.gov Identifier: NCT02713347.

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。

现在购买可享受最大优惠（买一年送三个月，买两年送一年），2024年2月10日起将不再享有该优惠。