Promoting Advance Care Planning as a Healthy Behavior

促进预先护理计划作为一种健康行为

• 批准号: 9284247
• 负责人: Terri R. Fried
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9284247
• 关键词: Abbreviations; Abbreviations; Address; Address; Advance Care Planning; Advance Care Planning; Advance Directives; Advance Directives; Age; Age; Americas; Americas; Analysis of Variance; Analysis of Variance; Area; Area; Attitude; Attitude; Behavior; Behavior; Behavioral; Behavioral; Belief; Belief; Caregivers; Caregivers; Caring; Caring; Chronic Disease; Chronic Disease; Clinical; Clinical; Clinical Services; Clinical Services; Cognitive; Cognitive; Communication; Communication; Computer Simulation; Computer Simulation; Computers; Computers; Connecticut; Connecticut; Counseling; Counseling; Data; Data; Decision Making; Decision Making; Disease; Disease; Elderly; Elderly; Eligibility Determination; Eligibility Determination; Emotional; Emotional; Ensure; Ensure; Equation; Equation; Equilibrium; Equilibrium; Evaluation; Evaluation; Expert Systems; Expert Systems; Face; Face; Feedback; Feedback; Future; Future; Goals; Goals; Health; Health; Health Status; Health Status; Health behavior; Health behavior; Health behavior change; Health behavior change; Healthcare; Healthcare; Healthcare Systems; Healthcare Systems; Individual; Individual; Institute of Medicine (U.S.); Institute of Medicine (U.S.); Intervention; Intervention; Interview; Interview; Judgment; Judgment; Life; Life; Living Wills; Living Wills; Longevity; Longevity; Maintenance; Maintenance; Measures; Measures; Medical; Medical; Modeling; Modeling; Motivation; Motivation; Multivariate Analysis; Multivariate Analysis; Outcome; Outcome; Outcome Measure; Outcome Measure; Pamphlets; Pamphlets; Participant; Participant; Patients; Patients; Phonation; Physicians; Physicians; Preparation; Preparation; Primary Health Care; Primary Health Care; Principal Investigator; Principal Investigator; Process; Process; Proxy; Proxy; Public Health; Public Health; Randomized Controlled Trials; Randomized Controlled Trials; Readiness; Readiness; Recording of previous events; Recording of previous events; Reporting; Reporting; Research Personnel; Research Personnel; Specific qualifier value; Specific qualifier value; Subgroup; Subgroup; Telephone; Telephone; Testing; Testing; Theoretical model; Theoretical model; Time; Time; Veterans; Veterans; Work; Work; base; base; behavior change; behavior change; care preference; care preference; cohort; cohort; design; design; end of life; end of life; end of life care; end of life care; experience; experience; follow-up; follow-up; group intervention; group intervention; health care quality; health care quality; improved; improved; insight; insight; intervention effect; intervention effect; loved ones; loved ones; meetings; meetings; middle age; middle age; motivational enhancement therapy; motivational enhancement therapy; motivational intervention; motivational intervention; patient oriented; patient oriented; preference; preference; premature; premature; sociodemographics; success; success; surrogate decision maker; surrogate decision maker; theories; theories; therapy design; therapy design; treatment as usual; treatment as usual

The recent Institute of Medicine report “Dying in America: Improving Quality and Honoring Individual Preferences near the End of Life” endorses advance care planning (ACP) as a key component of quality healthcare. In contrast to the prevailing model of engaging only individuals with serious illness in ACP, it proposes a continuous process, starting earlier in the lifespan with individuals in good health. Such an approach helps to prepare the individual for more in-depth discussions and treatment decision making as more serious illness develops. This project is responsive to this call. It builds upon earlier work of the Principal Investigator (PI) providing two key insights for improving the process of ACP. The first of these is shifting the purpose of ACP away from the pre-specification of treatment preferences to preparation for making the best possible “in-the-moment” healthcare decisions. This is accomplished by conceptualizing ACP as acts of communication among patients, surrogates, and clinicians. The second is explicitly addressing the many attitudinal, cognitive, and behavioral barriers to engagement in ACP. This is accomplished by treating ACP as a health behavior and intervening using validated models for health behavior change. The PI has developed and pilot-tested an intervention based on the Trans-Theoretical Model. This intervention consists of an expert system that assesses an individual's readiness to engage in ACP along with the attitudes and beliefs influencing the desire, motivation, and ability to engage. It then provides individually tailored feedback materials providing information, motivation, and/or behavior change strategies (computer-tailored information or CTI). This project will also utilize a form of motivational interviewing called motivational enhancement therapy (MET), which, while also including the concept of readiness for behavior change, is distinct from CTI. It consists of brief counseling exploring an individual's readiness to engage in behavior change and helping the individual to identify motivators for change. The objective of the project is to examine the effects of CTI and MET on Veteran engagement in ACP. The specific aim is: To conduct a randomized controlled trial examining the effects of: a) usual care; b) CTI; c) MET; d) CTI + MET on the proportion of middle-age and older Veterans receiving primary care at the VA who complete the process of ACP. Broad eligibility criteria will be used to identify Veterans age 55 years and older who are receiving primary care within VA Connecticut Healthcare System and who have not completed all of the 4 key ACP behaviors: health care proxy assignment, living will completion, communication with the health care proxy about views on quality vs. quantity of life, communication with the clinician about these views. The intervention(s) will be delivered over the phone. For Veterans receiving CTI, an individually tailored feedback report, a stage-matched brochure, and a pamphlet for the surrogate will be mailed. This will be repeated at 2 and 4 months. For Veterans receiving MI, the Veteran and surrogate will participate in a dyadic interview. Follow-up interviews will occur at 2 and 4 months. For Veterans receiving CTI + MI, the printed materials will be mailed, and the interview will be conducted within 2 weeks. Baseline measures, including stage of change for the 4 key ACP behaviors, pros and cons of behavior change, and health status and sociodemographic variables, will be obtained for all participants. The outcome measure, obtained at 6 months, will be the proportion of participants who have completed the 4 ACP behaviors. The proposal will also lay the groundwork for more widespread implementation by collecting implementation data on the time and effort required to deliver the interventions, success of and barriers to delivering the interventions, and spill-over effects on other clinical services. Additional work will be done to strategize about the most efficient ways to embed the interventions into existing clinical services.

最近的医学研究所报告“在美国死亡：提高质量和尊重个人 生命快要结束的偏好”认可了预先护理计划（ACP）作为质量的关键组成部分 卫生保健。与仅在ACP中与患有严重疾病的人一起参与的普遍模型相反， 提案是一个持续的过程，从寿命较早开始，身体身体健康。 方法有助于为个人做好准备，以进行更深入的讨论和治疗决策，随着更多 严重的疾病发展。该项目对此电话有响应。它以校长的早期工作为基础 研究者（PI）提供了两个关键见解，以改善ACP的过程。第一个是转移 ACP远离预先指定治疗偏好的目的，以做好准备 可能的“主义”医疗保健决策。这是通过将ACP概念化为 患者，代理和临床医生之间的沟通。第二个明确解决了许多 参与ACP的态度，认知和行为障碍。这是通过将ACP视为 健康行为和使用经过验证的健康行为改变模型进行干预。 PI已经发展 并试用了基于跨理论模型的干预措施。该干预措施由专家组成 评估个人准备与参加者一起参与ACP的系统并相信 影响欲望，动力和参与能力。然后，它提供单独量身定制的反馈 提供信息，动机和/或行为变更策略的材料（计算机计算的信息 或CTI）。该项目还将利用一种激励性访谈形式称为动机增强 疗法（MET），虽然还包括对行为改变准备的概念，但与CTI不同。它 包括探索个人准备进行行为改变和帮助的简短咨询 个人以识别变革的电动机。 该项目的目的是检查CTI的影响并满足对ACP的退伍军人参与的影响。 具体目的是：进行一项随机对照试验，检查以下效果：a）常规护理； b）cti; c） 大都会d）CTI +在中期和老年退伍军人的比例上遇到了VA的初级保健 完成ACP的过程。广泛的资格标准将用于识别55岁及以上的退伍军人 谁在VA康涅狄格州的医疗保健系统中获得初级保健，并且尚未完成所有 4个关键的ACP行为：医疗保健代理，生活将完成，与健康沟通 关心有关质量与生活数量的观点，与这些观点的临床交流的关注。这 干预将通过电话进行。对于接受CTI的退伍军人，是一个单独量身定制的反馈 报告，舞台匹配的小册子和代理人的小册子将被邮寄。这将在2重复 和4个月。对于接受MI的退伍军人，退伍军人和代理人将参加二元采访。 后续采访将在2和4个月进行。对于接收CTI + MI的退伍军人，印刷材料将 被邮寄，面试将在2周内进行。基线措施，包括变化阶段 对于4个关键的ACP行为，行为改变的利弊以及健康状况和社会人口统计学 将为所有参与者获得变量。在6个月时获得的结果度量将是 完成了4个ACP行为的参与者的比例。该提议还将为基础奠定基础 通过收集有关所需的时间和精力的实施数据，以进行更多的宽度实施 提供干预措施的干预措施，成功和障碍以及对其他的溢出影响 临床服务。将对最有效的嵌入方法进行额外的工作 干预现有临床服务。