Promoting Behavior Change to Increase Engagement in Advance Care Planning

促进行为改变以增加对预先护理计划的参与

• 批准号: 8112969
• 负责人: Terri R. Fried
• 金额: $ 20.89万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8112969
• 关键词: Abbreviations; Advance Care Planning; Advance Directives; Behavior; Budgets; Caring; Communication; Complement; Conceptions; Decision Making; Development; Elderly; Ensure; Equilibrium; Expert Systems; Exploratory/Developmental Grant; Feedback; Foundations; Funding; Goals; Health behavior; Health behavior change; Healthcare; Individual; Intervention; Intervention Studies; Living Wills; Maintenance; Modeling; Outcome; Pamphlets; Participant; Patient Care; Patients; Persons; Physicians; Population; Preparation; Procedures; Process; Proxy; Readiness; Recruitment Activity; Reporting; Research; Sampling; Specific qualifier value; Staging; Surveys; Testing; Time; TimeLine; Writing; base; behavior change; community setting; computer generated; computerized; cost; design; effective intervention; end of life; improved; meetings; preference; self help; successful intervention; surrogate decision maker; therapy design; therapy development

DESCRIPTION (provided by applicant): The concept of advance care planning (ACP) is evolving. ACP was originally conceptualized as the process by which patients could specify in advance the treatment they would want to receive if they became decisionally incapable. Traditionally, it consisted of the completion of advance directives (AD). However, it has been shown that the completion of documents, while most likely necessary, is not in and of itself sufficient to improve end-of-life outcomes. This has led to newer conceptions of ACP as an act of communication, between patients and surrogates, and between patients and physicians, that focuses not on preferences for specific treatments but rather on broader goals of care. These newer conceptions achieve a number of important outcomes, including improving the quality of end-of-life decision-making, decreasing the burden associated with surrogate decision-making, and helping to ensure that the care patients receive at the end of life is consistent with their core values. Reviews of intervention studies to engage patients in ACP conclude that they have had only modest effects. The majority of interventions designed to increase rates of ACP participation have focused on the completion of ADs and also assume that patients are prepared for this participation. There is growing evidence, however, that individuals have variable readiness to participate, and that intervention materials aimed at persons who are ready to participate will not be effective for those at earlier stages of readiness. In this way, ACP is similar to many other health behaviors, for which models of health behavior change have served as the framework for successful interventions. This project builds upon a body of work demonstrating the applicability of the Transtheoretical Model (TTM) to ACP. The TTM is a model of health behavior change that has been used as the foundation for a large and growing number of effective interventions aimed at a wide range of behaviors. The current proposal seeks to develop an interactive, individualized, TTM-tailored intervention which can be delivered cost-effectively to large segments of a population, and at the same time, be tailored to individuals. In this proposal, ACP is defined as consisting of four components: 1) clarification of goals of care; 2) communication with surrogates physicians regarding these goals; 3) communication with physicians regarding these goals; and 4) completion of written documents. The specific aims are: Primary Aim 1: To develop a TTM-tailored intervention designed to increase the rates of older persons' participation in ACP: Primary Aim 2: To determine the feasibility of the TTM intervention by pilot-testing procedures for delivering the intervention and assessing the acceptability and clarity of intervention materials. Primary Aim 3. To revise the intervention materials based on participants' feedback. PUBLIC HEALTH RELEVANCE: Traditional approaches to interventions aimed at increasing rates of advance care planning focus are action- oriented; in other words, they provide steps that persons will take only if they are prepared or ready to participate. The proposed study, in contrast, seeks to develop an intervention providing steps for persons to take tailored to all stages of readiness. By meeting individuals' needs for behavior change, such an approach holds the promise of providing benefits to a larger portion of the population as compared to traditional intervention approaches.

描述（由申请人提供）：预先护理计划（ACP）的概念正在发展。 ACP最初被概念化为患者可以在决策上无法做出的治疗方法提前指定的治疗过程。传统上，它由预先指示的完成（AD）组成。但是，已经表明，文件的完成虽然很可能是必要的，但本身并不足以改善寿命终结的结果。这导致了ACP作为一种沟通，患者和替代物之间以及患者和医生之间的较新概念，这些概念并不关注特定治疗的偏好，而是针对更广泛的护理目标。这些较新的概念取得了许多重要的结果，包括提高寿命终止决策的质量，减轻与替代决策相关的负担，并帮助确保患者在生命结束时获得的护理患者与他们的核心价值一致。 干预研究的综述使患者参与ACP，得出的结论是他们只有适度的影响。旨在提高ACP参与率的大多数干预措施都集中在AD的完成上，并且还假设患者已为此参与做好准备。但是，有越来越多的证据表明，个人有可变的准备工作，并且针对准备参与的人的干预材料对于早期准备就绪的人来说不会有效。这样，ACP与许多其他健康行为相似，为此，健康行为的模式已成为成功干预措施的框架。该项目建立在一系列工作的基础上，证明了跨理论模型（TTM）对ACP的适用性。 TTM是一种健康行为改变模型，已被用作针对广泛行为的大量有效干预措施的基础。当前的提案旨在开发一种互动，个性化的TTM限制干预措施，该干预措施可以成本效率地交付给大部分人群，同时量身定制为个人。在此提案中，ACP定义为由四个组成部分组成：1）澄清护理目标； 2）与代孕医生就这些目标进行沟通； 3）与医生就这些目标进行沟通； 4）书面文件的完成。具体目的是：主要目的1：开发旨在提高老年人参与ACP的速度的TTM泰式干预措施：主要目的2：确定通过试点测试程序提供干预措施的TTM干预措施的可行性，以提供干预并评估干预材料的可接受性和清晰性。主要目的3。根据参与者的反馈修改干预材料。 公共卫生相关性：旨在提高预先护理计划重点率的干预措施的传统方法是面向行动的；换句话说，它们提供了只有在准备或准备参加的情况下才能采取的步骤。相比之下，拟议的研究试图制定一项干预措施，为人们提供针对所有准备就绪阶段的量身定制的步骤。通过满足个人对行为改变的需求，与传统的干预方法相比，这种方法有望为大部分人口提供利益。