Empowering Formerly Homeless Older Adults to Engage in Advance Care Planning in Permanent Supportive Housing (ACP-PSH): An RCT

帮助以前无家可归的老年人参与永久支持性住房中的预先护理计划 (ACP-PSH)：一项随机对照试验

• 批准号: 10639204
• 负责人: MARGARET Anne HANDLEY
• 金额: $ 93.25万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10639204
• 关键词: Acceleration; Address; Adoption; Adult; Advance Care Planning; Advance Directives; Age; Age Years; Aging; Anxiety; Attention; Caring; Chronic; Chronic Disease; Cluster randomized trial; Communities; Consolidated Framework for Implementation Research; Decision Making; Disparity; Effectiveness; Effectiveness of Interventions; Elderly; Evidence based program; Face; Family; Feedback; Focus Groups; Funding; Goals; Healthcare; High Prevalence; Homeless persons; Homelessness; Housing; Hybrids; Individual; Intervention; Intervention Trial; Interview; Left; Measures; Medical; Methods; Modeling; Participant; Patients; Persons; Policies; Population; Premature Mortality; Preparation; Process; Public Health; Quality of life; Randomized; Randomized, Controlled Trials; Reading; Reduce health disparities; Reporting; Research; Resources; Sampling; Services; Site; Social isolation; Surveys; Testing; Time; United States National Institutes of Health; Visit; Work; Writing; arm; behavior change; behavior change wheel; compare effectiveness; contextual factors; design; digital; effectiveness testing; empowerment; end of life; evidence base; experience; fifth grade; follow-up; health literacy; high risk; high risk population; implementation evaluation; implementation science; improved; marginalized population; member; mortality; mortality risk; movie; novel; pet animal; preference; primary outcome; programs; secondary outcome; supported housing; theories; tool; trial comparing; uptake

PROJECT SUMMARY/ABSTRACT Background: The homeless population is aging, with an increasing proportion of individuals over age 50 who experience accelerated aging, high rates of mortality, and a high risk of not having their wishes honored at the end of life. Advance care planning (ACP) aims to elicit patients’ medical preferences; yet older homeless adults have low rates of ACP. Significant policy attention has focused on rehousing chronically homeless people into Permanent Supportive Housing (PSH), subsidized permanent housing with voluntary supportive services. Our previous research indicates that PSH may be the ideal setting to initiate ACP; however, no studies have engaged formerly homeless PSH residents in ACP. Our team has created PREPARE for Your Care (PREPARE) – an easy-to-use, evidence-based, online ACP program with video stories. This program includes easy-to-read advance directives, an ACP group visit guide, and an ACP one-on-one facilitation guide. Through a prior R34, we developed a Community Advisory Board (CAB) and together identified preliminary adaptations to PREPARE for the PSH setting. The project requires a final co-development process with formerly chronically homeless older PSH residents and staff and our CAB. The objective of this proposal is to co-develop PREPARE-PSH and compare the effectiveness of facilitated group versus one-on-one visits among formerly chronically homeless older adults in PSH. Aims: We will (1) co-develop PREPARE-PSH with PSH residents, staff, and our CAB; (2) conduct a Hybrid (NIH Stage III efficacy/effectiveness), Type 1, two-arm, cluster randomized trial comparing the effectiveness of two delivery strategies of the PREPARE-PSH program (i.e., ACP movies and easy-to-read ADs) – facilitated group vs. one-on-one visits; and (3) explore implementation- relevant factors associated with ACP engagement and sustainability of ACP in PSH. Methods: In Aim 1 we will engage in a rigorous co-development process through in-depth interviews and focus groups with 20 PSH residents and the CAB. We will use a theory-informed framework (i.e., Behavior Change Wheel (BCW)) and qualitative content analysis to co-create a PREPARE-PSH program. For Aim 2, the CAB noted that groups may be more feasible to scale vs. one-on-one visits and asked us to randomize by site so residents would not feel “left out” of the alternate intervention. Therefore, we will conduct a Hybrid (NIH Stage III efficacy/effectiveness), Type 1 cluster randomized trial comparing delivery of PREPARE-PSH through facilitated groups vs. one-on-one visits using mixed effects models. Randomization will be at the site level, balanced by site size. In Aim 3 we will purposively sample Aim 2 participants for in-depth interviews (n=40-50), conduct focus groups with PSH staff (n=40), and obtain input from CAB members (total n=15). We will explore implementation-relevant factors associated with: (a) high and low ACP engagement and sustainability of PREPARE-PSH using the BCW and the Consolidated Framework for Implementation Research (CFIR) model. Relevance to NIH and public health: PREPARE-PSH may reduce health disparities in ACP among formerly chronically homeless older adults.

项目摘要/摘要 背景：无家可归的人口正在老化，50岁以上的人比例越来越 经验加速衰老，高死亡率以及没有兑现愿望的高风险 生命的尽头。预先护理计划（ACP）旨在引起患者的医疗偏好；然而年龄较大的无家可归的成年人 ACP率较低。重大的政策关注集中在重新安置的长期无家可归者中 永久支持住房（PSH），通过自愿支持服务补贴永久性住房。我们的 先前的研究表明，PSH可能是启动ACP的理想环境。但是，没有研究 曾在ACP参与以前无家可归的PSH居民。我们的团队为您的护理做准备 （准备） - 带有视频故事的易于使用的，基于证据的在线ACP程序。该程序包括 易于阅读的预先指示，ACP小组访问指南和ACP一对一的设施指南。通过 先前的R34，我们开发了一个社区顾问委员会（CAB），并共同确定了初步改编 为PSH设置做准备。该项目需要最终的共同开发过程 无家可归的老年PSH居民和员工以及我们的出租车。该提议的目的是共同开发 准备PSH并比较准备小组的有效性与以前的一对一访问 长期无家可归的老年人在PSH中。目的：我们将（1）与PSH居民共同开发PSH， 员工和我们的出租车； （2）进行混合动力（NIH III期有效性/有效性），类型1，两臂群集 随机试验比较了准备PSH计划的两种交付策略的有效性（即 ACP电影和易于阅读的广告） - 促进团体与一对一访问； （3）探索实施 - 与ACP在PSH中的ACP参与和可持续性相关的相关因素。方法：在AIM 1中，我们将 通过深入的访谈进行严格的共同开发过程，并与20个PSH进行焦点小组 居民和出租车。我们将使用一个理论知识的框架（即行为改变轮（BCW））和 定性内容分析以共同创建准备PSH计划。对于AIM 2，出租车指出小组 比例比一对一访问更可行，并要求我们按场地随机分组，以免 感觉“遗漏”替代干预措施。因此，我们将进行混合动力（NIH III期 有效性），1型群集随机试验比较了通过 使用混合效应模型促进的组与一对一的访问。随机化将在站点级别， 按场地大小平衡。在AIM 3中，我们通常会为AIM 2参与者采样，以进行深入访谈（n = 40-50）， 与PSH员工（n = 40）进行焦点小组，并从CAB会员获得输入（总n = 15）。我们将探索 与以下方面相关的与实施相关的因素：（a）ACP高和低的参与度和可持续性 使用BCW和实施研究（CFIR）模型的合并框架进行准备。 与NIH和公共卫生的相关性：准备PSH可能会降低ACP的健康差异 长期无家可归的老年人。