Palliative Video Consultation and Symptom Distress Among Rural Inpatients
Notice bibliographique
Résumé
Importance: Palliative care has been shown to improve important patient outcomes but is rarely available in small or rural hospitals. Objective: To assess whether culturally based palliative care video consultation could improve symptom distress compared with usual inpatient care without palliative care. Design, Setting, and Participants: Recruitment for this multisite, single-blind randomized clinical trial occurred from July 20, 2020, to December 20, 2023; data collection was completed on January 15, 2024. A community-aided approach was used to recruit inpatients from 3 rural hospitals lacking palliative care services in Alabama, Mississippi, and South Carolina. Self-identified non-Hispanic Black or African American and non-Hispanic White adults aged 55 years or older admitted with a serious chronic illness and a willing caregiver were invited to participate. Randomization was stratified by site and race. Interventions: Participants were randomized 1:1 to Community Tele-Pal, culturally based video consultation by a palliative care specialist followed by research coordinator (RC) contacts 3 and 6 days after video consultation (intervention arm), or to routine hospital care (control arm). Main Outcomes and Measures: The primary outcome was the between-group difference in the change in patient-reported symptom distress from baseline to day 7, assessed by the Edmonton Symptom Assessment Scale (ESAS; range, 0-90; lower scores indicate lower symptom distress). Secondary outcomes were quality of life (QOL; Patient-Reported Outcomes Measurement Information System global physical and mental health mean T scores), resource use (emergency department visits and hospital readmissions), and an exploratory outcome of feeling heard and understood. Results: A total of 209 patients were randomized (104 to usual care; 105 to the intervention); mean (SD) age was 73.3 (8.3) years, 120 (57.4%) were female, 58 (27.8%) were Black or African American, 157 (75.1%) were retired, and 75 (35.9%) had a Palliative Performance Scale score less than 70% (indicating need for functional assistance). On day 7, the mean (SE) ESAS score change from baseline was -11.4 (1.5) points in the intervention group and -7.3 (1.5) points in the control group; the between-group difference in change in ESAS scores was not statistically significant (Westfall d, -0.28; 95% CI, -0.56 to 0.01; P = .055). The mean (SE) day 7 between-group difference in ESAS score of -4.0 (1.8) points met the criteria for a minimal clinically important difference of 3 to 4 points. No between-group differences were observed for QOL, resource use, or feeling heard and understood. Conclusions and Relevance: In this randomized clinical trial, the intervention was not associated with reduced symptom distress at day 7 vs baseline or with improved QOL or reduced resource use compared with usual care. However, the between-group difference in the ESAS score met the criteria for a minimal clinically important difference of 3 to 4 points. Palliative video consultation to reduce health care inequities for hospitalized rural-dwelling individuals may warrant further investigation. Trial Registration: ClinicalTrials.gov Identifier: NCT03767517.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».