Improving goals-of-care discussions for patients with chronic life-limiting illness and acute respiratory failure

改善慢性生命限制性疾病和急性呼吸衰竭患者的护理目标讨论

• 批准号: 10347636
• 负责人: Robert Ying-Fu Lee
• 金额: $ 18.79万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10347636
• 关键词: Acute respiratory failure; Admission activity; Adopted; Adoption; Area; Behavioral; Caring; Chronic; Chronic Disease; Clinical Investigator; Clinical Trials; Communication; Data; Decision Making; Discipline of Nursing; Documentation; Electronic Health Record; Environment; Environmental Risk Factor; Ethnic Origin; Etiology; Exclusion; Expectancy; Family; Foundations; Future; Goals; Guidelines; Health; Health system; Incidence; Intensive Care; Intervention; Interview; Lead; Life; Logistic Regressions; Measurement; Measures; Mechanical ventilation; Medicine; Mentors; Methods; Minority; Natural Language Processing; Observational Study; Outcome; Outpatients; Palliative Care; Patient Care; Patient-Focused Outcomes; Patients; Physicians; Population; Process; Prognosis; Public Health; Publishing; Race; Reporting; Research; Research Activity; Research Design; Research Methodology; Research Training; Scientist; Severity of illness; Structure; Surveys; Testing; Theoretical Domains framework; Time Factors; Training; Training Activity; Universities; Washington; Work; analytical method; base; behavior change; career; cohort; cost; design; disability; effectiveness implementation study; effectiveness implementation trial; experience; high risk; improved; improved outcome; medical schools; mortality risk; novel strategies; patient oriented research; preference; primary outcome; prognostic; randomized trial; secondary outcome; shared decision making; therapy design; usability

PROJECT SUMMARY/ABSTRACT Patients with chronic life-limiting illness who develop acute respiratory failure are at high risk of death and disability. Because some such patients would choose to forego life-sustaining treatments in certain conditions, it is important that ICU clinicians assess patients’ values, goals, and treatment preferences, and incorporate these findings into shared decision-making to provide goal-concordant care. Unfortunately, my preliminary data as well as qualitative studies of other hospitalized populations suggest that ICU clinicians often miss opportunities to assess or incorporate patients’ goals of care into decision-making. This may lead to the delivery of unwanted intensive care and life-sustaining treatments, which is harmful to both patients and families, and results in the delivery of high-cost, low-value care. The proposed research in this application will use multimethod and mixed-methods approaches to: (1) examine current implementation of goals-of-care discussions for patients with acute respiratory failure and chronic life- limiting illness; (2) identify potentially modifiable clinician behavioral determinants that underlie deficiencies in goals-of-care communication, and iteratively redesign an existing outpatient communication-priming intervention toward the goal of promoting high-quality goals-of-care discussions in the ICU; and, (3) conduct a pilot randomized trial of the redesigned communication-priming intervention to improve the occurrence and quality of documented goals-of-care discussions for patients with acute respiratory failure and chronic life- limiting illness. Through a combination of mentored research activities and formal research training, I will receive valuable research training in analytical methods to enhance the validity of studies that use “real-world” data, application of mixed-methods research to inform health intervention design, and clinical trials. The proposed research and training activities will prepare me for a career as an independent clinical investigator, and will form the foundation for a body of research designed to improve outcomes for patients with acute respiratory failure. These research and training activities will be facilitated by the academically rich research environments of the University of Washington Schools of Medicine, Nursing, and Public Health, as well as the Cambia Palliative Care Center of Excellence at UW Medicine.

项目摘要/摘要 患有慢性生命疾病的患者患有急性呼吸衰竭的患者处于高死亡风险和 残疾。因为某些这样的患者会选择在某些情况下放弃维持生命的治疗 重要的是，ICU临床医生评估患者的价值，目标和治疗偏好，并纳入 这些发现是共同的决策，以提供目标符合护理。不幸的是，我的初步数据 以及对其他住院人群的定性研究表明，ICU临床医生常常错过 评估或将患者的护理目标纳入决策的机会。这可能会导致 提供不必要的重症监护和维持生命的治疗，这对患者和 家庭，并导致提供高成本的低价值护理。 本应用程序中拟议的研究将使用以下方式使用多方法和混合方法的方法：（1）检查 目前针对患有急性呼吸衰竭和慢性寿命的患者进行护理的讨论目标 - 限制疾病； （2）确定潜在的可修改的临床行为决定者 护理沟通目标，并迭代地重新设计现有的门诊通信宣传 干预旨在促进ICU中高质量的护理讨论的目标； （3）进行一次 对重新设计的沟通干预措施的试验随机试验，以改善发生和 急性呼吸衰竭和慢性寿命的患者的保健讨论质量质量 限制疾病。 通过修改研究活动和正式研究培训的结合，我将获得价值 分析方法的研究培训，以提高使用“现实世界”数据的研究的有效性，应用 混合方法研究，以告知健康干预设计和临床试验。拟议的研究和 培训活动将使我成为独立临床研究者的职业，并将形成 旨在改善急性呼吸衰竭患者预后的一系列研究基础。 这些研究和培训活动将由学术丰富的研究环境准备 华盛顿大学医学，护理和公共卫生学校以及Cambia姑息 UW Medicine的卓越护理中心。