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An exploration of the prevalence and experience of cardiac cachexia: protocol for a mixed methods cross-sectional study
BMC Palliative Care ( IF 3.1 ) Pub Date : 2019-10-20 , DOI: 10.1186/s12904-019-0471-0
Matthew A Carson 1 , Joanne Reid 1 , Loreena Hill 1 , Lana Dixon 2 , Patrick Donnelly 3 , Paul Slater 4 , Alyson Hill 5 , Donna Fitzsimons 1
Affiliation  

Cachexia is a complex and multifactorial syndrome defined as severe weight loss and muscle wasting which frequently goes unrecognised in clinical practice [1]. It is a debilitating syndrome, resulting in patients experiencing decreased quality of life and an increased risk of premature death; with cancer cachexia alone resulting in 2 million deaths per annum [2]. Most work in this field has focused on cancer cachexia, with cardiac cachexia being relatively understudied – despite its potential prevalence and impact in patients who have advanced heart failure. We report here the protocol for an exploratory study which will: 1. focus on determining the prevalence and clinical implications of cardiac cachexia within advanced heart failure patients; and 2. explore the experience of cachexia from patients’ and caregivers’ perspectives. A mixed methods cross-sectional study. Phase 1: A purposive sample of 362 patients with moderate to severe heart failure from two Trusts within the United Kingdom will be assessed for known characteristics of cachexia (loss of weight, loss of muscle, muscle mass/strength, anorexia, fatigue and selected biomarkers), through basic measurements (i.e. mid-upper arm circumference) and use of three validated questionnaires; focusing on fatigue, quality of life and appetite. Phase 2: Qualitative semi-structured interviews with patients (n = 12) that meet criteria for cachexia, and their caregivers (n = 12), will explore their experience of this syndrome and its impact on daily life. Interviews will be digitally recorded and transcribed verbatim, prior to qualitative thematic and content analysis. Phase 3: Workshops with key stakeholders (patients, caregivers, healthcare professionals and policy makers) will be used to discuss study findings and identify practice implications to be tested in further research. Data collected as part of this study will allow the prevalence of cardiac cachexia in a group of patients with moderate to severe heart failure to be determined. It will also provide a unique insight into the implications and personal experience of cardiac cachexia for both patients and carers. It is hoped that robust quantitative data and rich qualitative perspectives will promote crucial clinical discussions on implications for practice, including targeted interventions to improve patients’ quality of life where appropriate.

中文翻译:

心脏恶病质的患病率和经历的探索:混合方法横断面研究方案

恶病质是一种复杂的多因素综合征,被定义为严重的体重减轻和肌肉萎缩,但在临床实践中经常被忽视[1]。这是一种使人衰弱的综合症,导致患者生活质量下降,过早死亡的风险增加;仅癌症恶病质每年就会导致 200 万人死亡 [2]。该领域的大多数工作都集中在癌症恶病质上,而心脏恶病质的研究相对不足——尽管其潜在的患病率和对晚期心力衰竭患者的影响。我们在此报告一项探索性研究的方案,该方案将: 1. 重点确定晚期心力衰竭患者中心脏恶病质的患病率和临床影响;2. 从患者和护理人员的角度探讨恶病质的经历。混合方法横断面研究。第一阶段:对来自英国两个信托基金的 362 名患有中度至重度心力衰竭的患者进行有目的的样本评估,以了解恶病质的已知特征(体重减轻、肌肉损失、肌肉质量/力量、厌食、疲劳和选定的生物标志物) ),通过基本测量(即中上臂围)和使用三份经过验证的问卷;关注疲劳、生活质量和食欲。第 2 阶段:对符合恶病质标准的患者 (n = 12) 及其护理人员 (n = 12) 进行定性半结构化访谈,将探讨他们对这种综合征的经历及其对日常生活的影响。在定性主题和内容分析之前,采访将以数字方式记录并逐字转录。第三阶段:将与主要利益相关者(患者、护理人员、医疗保健专业人员和政策制定者)​​举行研讨会,讨论研究结果并确定在进一步研究中测试的实践影响。作为本研究的一部分收集的数据将有助于确定一组中度至重度心力衰竭患者的心脏恶病质患病率。它还将为患者和护理人员提供关于心脏恶病质的影响和个人经历的独特见解。希望可靠的定量数据和丰富的定性视角将促进对实践影响的重要临床讨论,包括在适当的情况下采取有针对性的干预措施来改善患者的生活质量。
更新日期:2019-10-20
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