Emergency Medicine Palliative Care Access (EMPallA), United States, 2018-2022

According to the World Health Organization, palliative care is "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psycho-social and spiritual." The goal of the study was to generate comparative effectiveness research evidence to support the delivery of coordinated, community-based palliative care that effectively implements care plans consistent with the goals and preferences of older adults with advanced illness and their caregivers.
This study included a pragmatic, two-arm, multi-site randomized controlled trial of older adults (50+ years) with either poor prognosis cancer or end-stage organ failure who were recruited during an emergency department (ED) visit, along with their informal caregivers, to compare nurse-led telephonic case management to facilitated, outpatient specialty palliative care on: 1) quality of life in patients, 2) loneliness, 3) healthcare use in the 12 months following enrollment, 4) symptom burden, 5) caregiver strain, 6) caregiver quality of life, and 7) bereavement.

据世界卫生组织（World Health Organization, WHO）定义，姑息治疗（palliative care）是“通过早期识别、精准评估并治疗疼痛及躯体、心理社会、精神层面的其他问题，从而预防和缓解痛苦，以此改善罹患致命性疾病的患者及其家属的生活质量的照护模式”。本研究的目标是生成比较有效性研究证据，以支持协调式社区姑息照护的开展——该照护模式可依据晚期疾病老年患者及其照料者的治疗目标与偏好，有效落实照护方案。
本研究采用务实性两臂多中心随机对照试验设计，纳入了因急诊科（emergency department, ED）就诊招募的50岁及以上、预后不良的癌症患者或终末期器官衰竭患者，及其非正式照料者；旨在对比护士主导的电话病例管理与支持性门诊专科姑息照护在以下7个维度的效果：1）患者生活质量；2）孤独感；3）入组后12个月内的医疗资源使用情况；4）症状负荷；5）照料者负担；6）照料者生活质量；7）居丧反应。