The integrated Translational Health Research Institute of Virginia (iTHRIV): Using Data to Improve Health

弗吉尼亚综合转化健康研究所 (iTHRIV)：利用数据改善健康

基本信息

批准号：
10367106
负责人：
Donald E Brown
金额：
$ 16.99万
依托单位：
UNIVERSITY OF VIRGINIA
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10367106
关键词：
Address Area Arkansas Bioethics COVID-19 vaccine Caring Climacteric Clinic Clinical Clinical Ethics Code Collaborations Colorado Competence Consultations Country Critical Care Critical Illness Data Databases Decision Making Disease Distress Educational Curriculum Ethical Issues Ethicists Ethics Ethics Consultation Family Florida Goals Health Health Personnel Health Sciences Health system Healthcare Intensive Care Units Intervention Knowledge Laws Life Literature Modernization Monoclonal Antibodies Morals North Carolina Nurses Organizational Policy Outcome Study Pain Patient Care Patients Pattern Personal Satisfaction Physicians Physiological Play Policies Positioning Attribute Procedures RNA vaccine Research Research Institute Resources Role Science Scientific Advances and Accomplishments Services Source Structure Taxonomy Technology Training Translations Uncertainty Universities Virginia acute care aggressive breast cancer aggressive therapy arm base burnout clinical practice data harmonization design experience health care delivery health practice improved new technology novel novel therapeutics programs secondary analysis unethical

项目摘要

Project Summary/Abstract Healthcare interventions and technologies are appropriate and life-changing for some and clearly unethical or physiologically futile for others. The band of uncertainty that lies between these two extremes is a common source of ethical dilemmas in modern healthcare. For about 20% of patients in intensive care units, interventions may be life-prolonging but they offer little hope of survival outside the acute care setting—a situation called potentially inappropriate intervention. These situations arise due to multiple factors such as family demands, poor team collaboration, hierarchies that inhibit honest discussion, and societal norms that tend to default to aggressive treatments. Healthcare providers recognize these situations as burdensome for patients who endure high-tech, invasive procedures and treatments but who do not achieve meaningful benefit from them. As a result, healthcare providers feel they are complicit in wrongdoing--causing unnecessary suffering, prolonged dying, and lack of truth-telling—otherwise known as moral distress. An intervention to address this cause of moral distress is a type of ethics consultation called moral distress consultation. This health system-wide intervention is designed to assist healthcare providers experiencing moral distress to identify the causes and to design strategies to remedy the causes. Thus, this intervention seeks to improve patient care by acting on healthcare provider moral distress. A national Moral Distress Consultation Collaborative, composed of expert moral distress consultants from across the country is poised to more fully characterize the connection between burdensome interventions and moral distress with the goal of helping clinicians and families recognize and resolve situations of potentially inappropriate intervention. Consequently, the specific aims of this study are to 1) generate a taxonomy of barriers and strategies relevant to situations of potentially inappropriate intervention by harmonizing and evaluating a database from two moral distress consultation services, 2) evaluate organizational policies and state healthcare laws that play a role in potentially inappropriate interventions—specifically focusing on policies related to decision making and code status, and 3) define core competencies for moral distress consultation to promote knowledge and expertise among the nations moral distress consultants.

项目概要/摘要医疗保健干预措施和技术对于某些人来说是适当的并且可以改变他们的生活，并且明显不道德或介于这两个极端之间的不确定性在生理上是无用的。对于大约 20% 的重症监护病房患者来说，干预措施可能会延长生命，但在急性护理环境之外，它们几乎没有提供生存的希望—— 称为潜在不当干预的情况这些情况的出现是由于多种因素造成的，例如家庭要求、团队协作不良、阻碍诚实讨论的等级制度以及阻碍诚实讨论的社会规范医疗保健提供者倾向于默认采取积极的治疗方法，认为这些情况对患者来说是一种负担。忍受高科技、侵入性手术和治疗但未获得有意义的益处的患者结果，医疗保健提供者认为他们是不当行为的同谋，从而造成了不必要的后果。痛苦、长期死亡和缺乏说真话——也称为道德困境的干预。解决这种道德困扰的原因是一种道德咨询，称为道德困扰咨询。卫生系统范围内的干预旨在帮助遭受道德困扰的医疗保健提供者找出原因并设计解决原因的策略，因此，这种干预旨在改进。通过对医疗保健提供者的道德困境采取行动来护理患者全国道德困境咨询。由来自全国各地的道德困扰专家顾问组成的协作团队准备更充分地描述繁琐的干预措施与道德困境之间的联系，以帮助礼拜者和家庭认识并解决可能出现不当干预的情况。本研究的具体目标是 1) 生成与以下情况相关的障碍和策略的分类：通过协调和评估来自两种道德困境的数据库来进行可能不恰当的干预咨询服务，2) 评估在以下方面发挥作用的组织政策和州医疗保健法律潜在不适当的干预措施——特别关注与决策和代码相关的政策地位，以及 3) 定义道德困境咨询的核心能力，以促进知识和专业知识的发展国家道德困境顾问之一。