Surrogate/Clinician Communication: The Family Inpatient Communication Survey

代理人/临床医生沟通：家庭住院沟通调查

基本信息

批准号：
8480151
负责人：
Alexia Mary Torke
金额：
$ 32.81万
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：
2013
资助国家：
美国
起止时间：
2013-07-01 至 2017-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8480151
关键词：
Adult Age Agreement Anxiety Area Caring Clinical Clinical Research Communication Community Hospitals Conflict (Psychology)Consult Data Decision Making Delirium Dementia Distress Do Not Resuscitate Order Elderly Elements Emotional Ethics Face Factor Analysis Family Family member Future Geriatrics Goals Health Communication Hospice Care Hospitalization Hospitals Inpatients Intervention Interview Length of Stay Measures Medical Medical Staff Mental Depression Modeling Nurses Nursing Ethics Outcome Palliative Care Patient Care Patients Physicians Population Process Psychometrics Public Hospitals Regrets Relative (related person)Reporting Research Research Infrastructure Research Personnel Role Sampling Social Workers Stress Surveys Symptoms Testing Theoretical model Time Work Writing base demographics design experience improved instrument loved ones meetings outcome forecast post-traumatic stress preference programs public health relevance satisfaction secondary outcome suburb surrogate decision maker therapy development tool

项目摘要

DESCRIPTION (provided by applicant): As the population ages, a growing number of hospitalized older adults will require the assistance of family members and other surrogates to make medical decisions for them. There is evidence that communication between clinicians and surrogates is often poor, that surrogate decision makers experience high degrees of distress during and after hospitalization, and that patients sometimes receive care that is ineffective or unwanted. Our research group has proposed that the quality of communication between clinicians and surrogates improves both the quality of decision making and outcomes for both patients and their surrogates. However, we do not know which elements of communication are most important to the surrogates and should therefore be the focus of future intervention and we have a limited understanding of the mechanisms by which communication impacts outcomes for patients and surrogates. To gain a better understanding of these issues, we need a high quality instrument to assess surrogate/clinician communication and decision making in the hospital setting. To our knowledge, there is no well-validated instrument for this purpose. The current R01 proposal will validate a new instrument to measure the quality of communication between surrogate decision makers and clinicians in the hospital setting and will examine relationships between this measure and decision quality, surrogate distress and patient outcomes. This new measure, the Family Inpatient Communication Survey, examines several elements of communication that we have identified in our earlier work to be especially important for decision making, such as emotional support and frequent communication. We have drafted the instrument, conducted expert review and pilot tested it. The proposed R01 study will conduct the essential next step, validating the instrument with surrogate decision makers from 3 diverse hospitals in the Indianapolis area, including an urban public hospital, a tertiary referral center, and a suburban community hospital. We will also administer other well-validated measures of decision quality, surrogate outcomes (such as distress and depression), and patient care outcomes and will examine the relationships between communication quality, decision making quality, and patient and surrogate outcomes. We have assembled a diverse group of investigators with expertise in geriatrics, ethics, nursing and psychometrics. The research team will be advised by a Clinician Advisory Panel, including ICU physicians, a social worker and a nurse, to advise on the implementation of the study in the clinical setting. Findings from the current research will be crucial in the development of an intervention to improve communication and decision making in the hospital. The long term goal of this research agenda is to improve the quality of decisions for hospitalized patients and to improve the distress of surrogates who must make difficult choices for patients.

描述（由申请人提供）：随着人口老龄化，越来越多的住院老年人将需要家庭成员和其他代理人的帮助来为他们做出医疗决定。有证据表明，临床医生和代理人之间的沟通往往很差，代理人决策者在住院期间和住院后会经历高度的痛苦，并且患者有时会接受无效或不需要的护理。我们的研究小组提出，临床医生和代理人之间的沟通质量可以提高患者及其代理人的决策质量和结果。然而，我们不知道哪些沟通要素对代理人来说最重要，因此应该成为未来干预的重点，而且我们对沟通影响患者和代理人结果的机制了解有限。为了更好地理解这些问题，我们需要一个高质量的工具来评估医院环境中代理人/临床医生的沟通和决策。据我们所知，目前尚无经过充分验证的工具可用于此目的。当前的 R01 提案将验证一种新工具，用于衡量医院环境中替代决策者和临床医生之间的沟通质量，并将检查该衡量标准与决策质量、替代痛苦和患者结果之间的关系。这项新措施，即家庭住院患者沟通调查，检查了我们在早期工作中发现的对决策特别重要的几个沟通要素，例如情感支持和频繁沟通。我们起草了该文书，进行了专家评审并进行了试点测试。拟议的 R01 研究将进行重要的下一步，由来自印第安纳波利斯地区 3 家不同医院的代理决策者验证该工具，其中包括一家城市公立医院、一家三级转诊中心、和郊区社区医院。我们还将管理其他经过充分验证的决策质量、替代结果（例如痛苦和抑郁）和患者护理结果的衡量标准，并将检查沟通质量、决策质量以及患者和替代结果之间的关系。我们组建了一支多元化的研究人员小组，他们在老年病学、伦理学、护理学和心理测量学方面拥有专业知识。研究团队将接受包括 ICU 医生、一名社会工作者和一名护士在内的临床医生咨询小组的建议，就该研究在临床环境中的实施提供建议。当前研究的结果对于制定改善医院沟通和决策的干预措施至关重要。该研究议程的长期目标是提高住院患者决策的质量，并减轻必须为患者做出艰难选择的代理人的痛苦。