An Effectiveness-Implementation Trial of SPIRIT in ESRD

SPIRIT 在 ESRD 中的有效性实施试验

• 批准号: 10205754
• 负责人: MI-KYUNG SONG
• 金额: $ 15.6万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10205754
• 关键词: 2019-nCoV; Acute; Address; Admission activity; Advance Care Planning; Advance Directives; Affect; Anxiety; Area; Behavior; Belief System; COVID-19; COVID-19 pandemic; Caregivers; Caring; Cessation of life; Characteristics; Chronic Disease; Cluster randomized trial; Complex; Conflict (Psychology); Control Groups; Data; Decision Making; Disasters; Disease Outbreaks; Educational Background; End stage renal failure; Ethnic Origin; Exhibits; Family; Fright; Gender; Goals; Health; Healthcare; Hospitalization; Income; Individual; Infection; Intervention; Learning; Life; Literature; Longitudinal cohort study; Measures; Medical; Modeling; Natural Disasters; Outcome; Panic; Paper; Parents; Patient Recruitments; Patients; Perception; Questionnaires; Race; Readiness; Reflex action; Research; Resources; Risk; Social Change; Socioeconomic Status; Specific qualifier value; Stress; Time; Uncertainty; Update; Withdrawal; aggressive therapy; base; behavioral economics; behavioral/social science; care outcomes; care preference; cognitive performance; coronavirus disease; economic impact; effectiveness implementation trial; end of life; end of life care; end-of-life decision making; evidence base; experience; follow-up; group intervention; high risk; interest; multiple chronic conditions; novel; pandemic disease; post intervention; preference; psychologic; recruit; resilience; response; risk perception; sex; social; social health determinants; sociodemographics

ABSTRACT This R01 supplement submitted in response to NOT-OD-20-097, Research on the 2019 Novel Coronavirus and the Behavioral and Social Sciences, addresses one of the four focused areas specified in the notice: to examine “downstream health impacts resulting from social, behavioral, and economic impacts, including differences in risks and resiliency based on gender, race and ethnicity, socioeconomic status, and other social determinants of health.” The COVID pandemic has brought fear and uncertainty to all aspects of life and especially to medical care. Research has shown that after experiencing a natural disaster, people exhibit more risk averse behaviors, and that belief systems can change: people “update” their perception of background risk and perceive the world to be a much riskier place. Although studies have shown that values and preferences for end-of-life care are stable over time especially after individuals made an effort to actively think about their end-of-life preferences, another body of literature suggests that abrupt and disturbing social changes, such as disasters, can affect the psychological mechanisms underlying cognitive performance. The effects of a disaster may bring doubt to clinicians as well as to families regarding how to interpret an advance directive or end-of-life care preferences that were expressed some time prior to the pandemic. There is very little empirical data to guide advance care planning (ACP) with our sickest patients in the setting of a disaster and especially one that is so novel. Therefore, we seek to learn whether in the setting of this novel disaster patients with serious chronic illness are more or less likely to want aggressive treatment. This supplement research is to generate new empirical data on the impact of the COVIDE-19 pandemic on patients' end-of-life preferences, to address whether the stability of preferences is disrupted by the pandemic, and to identify patient characteristics, including race/ethnicity, associated with pre-/post-pandemic changes. We will leverage the parent study (R01NR017018), a cluster randomized trial of an evidence-based ACP intervention (SPIRIT), in which we are currently following 143 dyads (65% Blacks) who successfully completed both the baseline and 2- week post-intervention follow-up before the outbreak. In this new longitudinal cohort study, we will recruit 100 dyads from the pool of 143 to repeat the study assessment battery 2 more times along with new COVID-19 Stress Scales. The specific aims are to: 1) compare the stability of patients' goals-of-care preferences over time, from pre-outbreak to during-outbreak, by group (SPIRIT vs control) and estimate effect by race (Blacks and Whites); 2) assess the stability in the preparedness outcomes (dyad congruence, patient decisional conflict, and surrogate decision-making confidence) comparing pre-outbreak to during-outbreak by group, and estimate race effect; and 3) examine the associations of the COVID-19 Stress, sex, race/ethnicity, and other sociodemographic characteristics (e.g., education level, income) to change in the outcomes and the stability of patients' goals-of-care preferences after the COVID-19 outbreak.

抽象的 此R01补充是针对NOT-OD-20-097提交的，2019年小说冠状病毒的研究 以及行为和社会科学，介绍了通知中指定的四个重点领域之一： 检查“社会，行为和经济影响造成的下游健康影响，包括 基于性别，种族和种族，社会经济地位以及其他社会的风险和弹性差异 健康的决定因素。 特别是医疗保健。研究表明，经历了自然灾害后，人们暴露了更多 风险避开行为，而信仰体系可能会改变：人们“更新”对背景风险的看法 并认为世界成为一个风险更大的地方。尽管研究表明价值和偏好 因为寿命末护理会随着时间的流逝而稳定，尤其是在个人努力积极思考自己的 临终偏好，另一种文献表明，突然和令人不安的社会变化，例如 灾难会影响认知表现的心理机制。一个 灾难可能会对临床医生以及家庭对如何解释提前指令或 大流行前一段时间表达的临终护理偏好。几乎没有经验 与我们最恶心的患者一起在灾难的情况下，特别是 一个如此新颖。因此，我们试图了解在这个新颖的灾难患者的环境中 严重的慢性病或多或少需要积极治疗。这项补充研究是 生成有关Covide-19大流行对患者终止偏好的影响的新经验数据， 解决偏好的稳定性是否因大流行而禁用，并确定患者 特征，包括种族/民族，与大流行前变化有关。我们将利用 家长研究（R01NR017018），一项基于证据的ACP干预（精神）的聚类随机试验 我们目前正在遵循143个二元组（65％的黑人），他们成功完成了基线和2-- 爆发前干预后的随访。在这项新的纵向队列研究中，我们将招募100 从143池的二元组重复研究评估电池2次，以及新的Covid-19 压力尺度。具体目的是：1）比较患者护理目标的稳定性 时间，从爆发前到爆发期间，按小组（精神与控制）和种族估计效应（黑人 和白人）； 2）评估制备结果的稳定性（二元组合，患者决策 冲突和代孕决策信心）将爆发前爆发与小组爆发期间进行比较， 估计竞赛效应； 3）检查COVID-19压力，性别，种族/种族和其他的关联 社会人口统计学特征（例如，教育水平，收入）改变结果和稳定性 COVID-19-19爆发后患者的护理偏好。