An Intervention to Reduce Futile End of Life Care in Elderly Surgical Patients

减少老年手术患者徒劳的临终护理的干预措施

• 批准号: 7275175
• 负责人: Angela Diane Shoher
• 金额: $ 6.73万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-11 至 2010-07-10
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7275175
• 关键词: Acute; Admission activity; Affect; Aged, 80 and over; Aging; American; Andro-Diane; Caring; Chronically Ill; Communication; Comorbidity; Consensus; Critical Illness; Data; Economics; Elderly; Family; Family member; Futility; Gender; Goals; Grant; Health; Health Policy; Hospital Mortality; Institutes; Intensive Care Units; Intervention; Kidney Failure; Length of Stay; Literature; Living Wills; Location; Measurement; Measures; Mechanical ventilation; Medical; Medical Staff; Methodology; Modeling; Numbers; Nurses; Obesity; Operative Surgical Procedures; Outcome; Patients; Physicians; Population; Postoperative Period; Probability; Process; Provider; Public Health; Public Health Schools; Quality of life; Research; Resources; Risk; Score; Societies; Subgroup; Surgeon; Surveys; Techniques; United States; Withdrawing Care; aging population; base; cost; day; emotional distress; end of life; end of life care; expectation; human old age (65+); improved; interest; member; mortality; older patient; outcome forecast; programs; satisfaction; social; tool

DESCRIPTION (provided by applicant): Dr. Shoher has a strong interest in health policy and surgical outcomes in elderly, surgical patients. This grant will allow her to obtain a Doctorate of Public Health at the Johns Hopkins Bloomberg School of Public Health in advanced public health methodology. The goal of this proposal is to evaluate how improved communication and consensus building regarding the expectation of survival and quality of life between medical care providers and family members of elderly, surgical patients affects the decision to withdraw or limit futile, end of life care. This goal is in direct alignment with the National Institute of Aging, which supports programs of research on all aspects of aging, including the social aspects of growing older and the economic implications of an aging society. The primary hypothesis of this study is that improved communication about the prognosis of elderly (>65 years old), surgical patients with prolonged ICU stays (>5 days) will decrease futile, end of life care. For this study futility will be defined as prolonged care in patients who have less than a 1% chance of surviving 30 days. The first outcome of interest will be to develop and validate expected survival and quality of life scoring models for elderly surgical patients with prolonged (>5 days) ICU stays. The second outcome, to be gathered by survey data, will be to ascertain from medical providers and patient family members their expectation of survival and post-operative quality of life for elderly surgical patients. The nominal group technique will be used to reach a consensus on subjective measurements of survival and quality of life between the medical team and family members of the patient population. The third outcome as a result of this intervention will be to determine if consensus building and improved communication via weekly family meetings decrease futile, end of life care in elderly surgical patients Improved identification of patients who do not have an acceptable survival risk or expected quality of life, as determined by the patient and his/her family, may decrease futile, end of life care in surgical patients. Improved communication about a patient's prognosis between the medical staff and the family members of elderly, critically ill patients may also decrease futile care and improve overall satisfaction with end of life care. For the society at large decreasing futile, end of life care can help reduce the increasing medical cost and emotional distress associated with end of life care in our aging population.

描述（由申请人提供）：Shoher 博士对老年手术患者的健康政策和手术结果有着浓厚的兴趣。这笔赠款将使她能够在约翰霍普金斯大学彭博公共卫生学院获得先进公共卫生方法学的公共卫生博士学位。该提案的目的是评估医疗保健提供者和老年手术患者家属之间关于生存预期和生活质量的改善沟通和建立共识如何影响撤回或限制无效的临终护理的决定。这一目标与国家老龄化研究所直接一致，该研究所支持老龄化各个方面的研究计划，包括老龄化的社会方面以及老龄化社会的经济影响。本研究的主要假设是，改善对老年人（> 65 岁）、长期 ICU 住院（> 5 天）的手术患者预后的沟通将减少徒劳的临终关怀。在这项研究中，无效被定义为对存活 30 天的机会低于 1% 的患者进行长期护理。第一个令人感兴趣的成果是为长期（> 5天）入住 ICU 的老年手术患者开发和验证预期生存和生活质量评分模型。通过调查数据收集的第二个结果将是从医疗服务提供者和患者家属那里确定他们对老年手术患者的生存和术后生活质量的期望。名义小组技术将用于在医疗团队和患者家属之间就生存和生活质量的主观测量达成共识。这项干预措施的第三个结果将是确定通过每周家庭会议建立共识和改善沟通是否会减少老年外科患者的徒劳的临终关怀改善对不具有可接受的生存风险或预期治疗质量的患者的识别由患者及其家人决定的生命可能会减少手术患者的徒劳的临终关怀。改善医务人员和老年危重患者家属之间关于患者预后的沟通也可以减少无用的护理并提高对临终护理的总体满意度。对于整个社会来说，临终关怀可以帮助减少与老龄化人口的临终关怀相关的日益增加的医疗费用和情绪困扰。