晚期肺癌患者远程医疗与面对面早期姑息治疗：多站点随机临床试验

大量研究表明，早期姑息治疗改善了晚期癌症患者及其护理人员的生活质量和其他关键结果，尽管大多数患者缺乏这种循证护理模式。

 To evaluate whether delivering early palliative care via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non–small cell lung cancer (NSCLC).

评估通过安全视频对比面对面治疗提供早期姑息治疗对晚期非小细胞肺癌（NSCLC）患者的生活质量是否具有同等影响。

Randomized, multisite, comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 US cancer centers among 1250 patients within 12 weeks of diagnosis of advanced NSCLC and 548 caregivers.

2018年6月14日至2023年5月4日在22个美国癌症中心进行的随机、多站点、比较有效性试验，囊括了1250名确诊为晚期NSCLC的患者和548名护理人员。

Participants were randomized to meet with a specialty-trained palliative care clinician every 4 weeks either via video visit or in person in the outpatient clinic from the time of enrollment and throughout the course of disease. The video visit group had an initial in-person visit to establish rapport, followed by subsequent virtual visits.

参与者被随机分配，从入组之时起和整个疾病进程中，每4周通过视频访问或亲自到门诊与受过专业培训的姑息治疗临床医生会面。视频访问组首先进行了面对面的访问，以建立融洽的关系，随后继续进行了虚拟访问。

Equivalence of the effect of video visit vs in-person early palliative care on quality of life at week 24 per the Functional Assessment of Cancer Therapy-Lung questionnaire (equivalence margin of ± 4 points; score range: 0-136, with higher scores indicating better quality of life). Participants completed study questionnaires at enrollment and at weeks 12, 24, 36, and 48.

根据肺癌治疗功能评估问卷，视频访问与面对面访问早期姑息治疗对第24周生活质量的影响等效（等效范围±4分；得分范围：0-136，得分越高表示生活质量越好）。参与者在入组时以及第12、24、36和48周完成了研究问卷。

By 24 weeks, participants (mean age, 65.5 years; 54.0% women; 82.7% White) had a mean of 4.7 (video) and 4.9 (in-person) early palliative care encounters. Patient-reported quality-of-life scores were equivalent between groups (video mean, 99.7 vs in-person mean,97.7; difference, 2.0 [90% CI, 0.1-3.9]; P= .04 for equivalence). Rate of care giver participation in visits was lower for video vs in-person early palliative care (36.6% vs 49.7%; P< .001). Study groups did not differ in caregiver quality of life, patient coping, or patient and caregiver satisfaction with care, mood symptoms, or prognostic perceptions.

到24周时，参与者（平均年龄65.5岁；54.0%为女性；82.7%为白人）平均有4.7次（视频）和4.9次（面对面）早期姑息治疗经历。两组患者报告的生活质量评分相当（视频平均值为99.7，而现场平均值为97.7；差异为2.0[90%CI，0.1-3.9]；等效性P=0.04）。与面对面早期姑息治疗相比，视频早期姑息治疗的护理人员参与率较低（36.6%对49.7%；P<0.001）。研究组在护理人员的生活质量、患者应对方式、患者和护理人员对护理的满意度、情绪症状或预后感知方面没有差异。

The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC, underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery.

与面对面的早期姑息治疗相比，虚拟早期姑息治疗对晚期非小细胞肺癌患者的生活质量具有同等的影响，强调了通过远程医疗服务改善这种循证护理模式的巨大潜力。