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) 的概念正在不断发展。 ACP 最初的概念是这样一个过程，通过该过程，患者可以提前指定如果他们变得完全丧失能力，他们希望接受的治疗。传统上，它包括完成预先指示（AD）。然而，事实证明，完成文件虽然很可能是必要的，但其本身并不足以改善临终结果。这导致了 ACP 的新概念，即患者与代理人之间以及患者与医生之间的一种沟通行为，其重点不在于对特定治疗的偏好，而在于更广泛的护理目标。这些新概念实现了许多重要成果，包括提高临终决策的质量、减轻与替代决策相关的负担，以及帮助确保患者在临终时接受的护理是一致的与他们的核心价值观。 对让患者参与 ACP 的干预研究的审查得出的结论是，这些研究仅产生了适度的效果。大多数旨在提高 ACP 参与率的干预措施都集中于 AD 的完成，并假设患者已为这种参与做好准备。然而，越来越多的证据表明，个人的参与准备程度各不相同，针对准备好参与的人的干预材料对于那些处于早期准备阶段的人来说并不有效。这样，ACP 与许多其他健康行为类似，健康行为改变模型已成为成功干预的框架。该项目建立在一系列证明跨理论模型 (TTM) 对 ACP 的适用性的工作基础上。 TTM 是一种健康行为改变模型，已被用作大量且不断增加的针对各种行为的有效干预措施的基础。目前的提案旨在开发一种交互式、个性化、TTM 定制的干预措施，该干预措施可以经济高效地向大部分人群提供，同时针对个人进行定制。在该提案中，ACP 被定义为由四个部分组成：1）澄清护理目标； 2) 与代理医生就这些目标进行沟通； 3）就这些目标与医生进行沟通； 4) 完成书面文件。具体目标是： 主要目标 1：制定 TTM 定制干预措施，旨在提高老年人参与 ACP 的比率： 主要目标 2：通过实施干预措施的试点测试程序来确定 TTM 干预措施的可行性评估干预材料的可接受性和清晰度。主要目标 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比例的传统干预方法是以行动为导向的；换句话说，它们提供了人们只有在准备好或准备好参与时才会采取的步骤。相比之下，拟议的研究旨在开发一种干预措施，为人们提供适合各个准备阶段的措施。通过满足个人行为改变的需求，与传统的干预方法相比，这种方法有望为更大部分的人群带来好处。