POST Facilitation for Community Dwelling Older Adults with and without Dementia

为社区居住的患有或不患有痴呆症的老年人提供后期便利

基本信息

批准号：
10451751
负责人：
Alexia Mary Torke
金额：
$ 66.34万
依托单位：
INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10451751
关键词：
Academy Admission activity Adult Advance Care Planning Affect Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Anxiety Area Cardiopulmonary Resuscitation Caring Cessation of life Clinic Visits Clinical Cognitive Communication Communities Complex Computerized Medical Record Conflict (Psychology)Consumption Control Groups Counseling Decision Making Dementia Disease Distress Documentation Elderly Enrollment Ensure Face Family Family member Frail Elderly Goals Health Status Healthcare Systems Home Hospitalization Institute of Medicine (U.S.)Intensive Care Units Intervention Knowledge Life Light Measures Mechanical ventilation Medical Medicine Mental Depression Midwestern United States Modeling Nursing Homes Operative Surgical Procedures Outcome Measure Outpatients Patient Care Patient Outcomes Assessments Patient-Centered Care Patient-Focused Outcomes Patients Physicians Population Prevention Primary Health Care Process Randomized Controlled Trials Registered nurse Research Role Standardization Structure Surveys Testing Time Training Training Programs Well in self Writing attentional control base care costs community setting comorbidity comparison intervention cost cost effectiveness end of life end of life care evidence base frailty high risk improved metropolitan multiple chronic conditions post-traumatic stress preference primary outcome programs surrogate decision maker tool treatment planning

项目摘要

Advance care planning (ACP) is a process that supports decision making about the patient’s medical care in serious illness and at the end of life. Although some older adults retain independent decision making, many require a surrogate decision maker due to Alzheimer’s Disease and Related Dementias (ADRD). High quality ACP enables decisions to be made before a crisis arises and incorporates patient values and preferences into the process. Although such planning is essential to patient-centered care, many older adults with frailty and complex medical conditions including ADRD are never offered the opportunity to engage in high quality ACP. The Physician Orders for Life Sustaining Treatment (POLST) is a state of the art ACP tool that is used to document the preferences of seriously ill patients for several types of medical treatment. Although used for thousands of seriously ill older adults, high quality counseling for POLST is a time consuming process that does not fit easily into the busy world of outpatient medicine. One solution is facilitation of POLST forms by a non-physician, followed by review and signature by a physician. The most widely used facilitator training program is Respecting Choices Last Steps. However, there are no controlled trials that have tested the impact of the Last Steps program or of other POLST implementation programs on important patient outcomes. We will conduct a randomized controlled trial to study the effect of high quality POLST Facilitation on a population of community dwelling older adults with and without ADRD who qualify for POLST based on their health status. In order to be generalizable to the clinical setting, the study will include patients making their own decisions and those who require a surrogate due to ADRD. Patients will be enrolled from primary care practices in a Midwest metropolitan area and POLST Facilitation will be delivered in the home by registered nurses trained in the Last Steps model. The primary aim is to test the effects of high quality POLST Facilitation on whether or not patients receive medical treatment concordant with preferences, compared to an attention control group. We will also measure outcomes of decision quality, cost, and care at the end of life.

预先护理计划 (ACP) 是一个支持患者在重病和临终时的医疗护理决策的过程，尽管一些老年人保留独立决策权，但由于阿尔茨海默病和相关痴呆症，许多老年人需要代理决策者。 (ADRD) 高质量的 ACP 能够在危机发生之前做出决策，并将患者的价值观和偏好纳入流程中，尽管这种计划对于以患者为中心的护理至关重要，但许多患有包括 ADRD 在内的虚弱和复杂医疗状况的老年人。从未有机会参与高质量的 ACP。生命维持治疗医师指令 (POLST) 是一种最先进的 ACP 工具，用于记录重病患者对多种类型医疗的偏好。对于成千上万患有重病的老年人来说，高质量的 POLST 咨询是一个耗时的过程，不太适合繁忙的门诊医疗世界，一种解决方案是由非医生协助填写 POLST 表格，然后再进行。最广泛使用的辅导员培训计划是“尊重最后的步骤”。但是，没有对照试验测试了“最后的步骤”计划或其他 POLST 实施计划对重要患者结果的影响。开展一项随机对照试验，研究高质量 POLST 促进对患有或不患有 ADRD 的社区居住老年人（根据其健康状况符合 POLST 条件）的影响。为了推广到临床环境，该研究将进行。包括自己做出决定的患者以及因 ADRD 需要代孕的患者将从中西部大都市区的初级保健实践中入组，并且 POLST 协助将由接受过“最后步骤”模式培训的注册护士在家中提供。目的是测试高质量 POLST 促进对患者是否接受符合偏好的医疗治疗的影响，与注意力对照组相比，我们还将衡量临终决策质量、成本和护理的结果。