Mentored Patient Oriented Research in Improving Surrogate Decision Making for Patients with Advanced Respiratory Failure

指导以患者为导向的研究，以改善晚期呼吸衰竭患者的替代决策

• 批准号: 10641976
• 负责人: Douglas B White
• 金额: $ 11.02万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10641976
• 关键词: Active Learning; Acute respiratory failure; Address; Affect; Attitude; Award; Behavior; Caring; Collaborations; Communication; Country; Data; Data Set; Decision Making; Disease; Doctor of Philosophy; Ethics; Evidence based intervention; Family; Fostering; Funding; Goals; Growth; Health Services Research; Health system; Infrastructure; Intervention; Interview; Lead; Learning; Medical Care Costs; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Mid-Career Clinical Scientist Award (K24); Midcareer Investigator Award in Patient-Oriented Research; National Heart, Lung, and Blood Institute; Observational Study; Outcome; Patient-Centered Care; Patient-Focused Outcomes; Patients; Physicians; Positioning Attribute; Principal Investigator; Prognosis; Psyche structure; Psychology; Public Health; Reading; Research; Research Personnel; Resource Development; Resources; Respiratory Failure; Role; Science; Scientist; Senior Scientist; Social Psychology; Structure; Techniques; Testing; Time; Training; United States; United States National Institutes of Health; Universities; Utility Theories; Work; career; career development; effective intervention; end of life; improved; improved outcome; innovation; insight; medical schools; mentoring community; next generation; overtreatment; patient oriented; patient oriented research; preference; programs; public health relevance; shared decision making; skills; success; surrogate decision maker; surrogate decision making; symposium

ABSTRACT The goal of this Midcareer Investigator Award in Patient-Oriented Research is to enhance the ability of Dr. Douglas White to train, mentor, and support the career development of clinician-scientists focused on developing and testing interventions to improve surrogate decision making for incapacitated patients with advanced respiratory failure. Patients with acute respiratory failure and a poor prognosis often receive intensive, burdensome treatments near the end of life that are inconsistent with their values and preferences. This is an important public health problem because 1) patient-centered care near the end of life is a central aspect of ethical, humane care, and 2) overtreatment near the end of life contributes to the disproportionate costs of medical care near the end of life in the U.S. Although the scope of the problems is well documented, there are few evidence-based interventions to improve patient outcomes. Solving this problem will require the collaboration of scientists with expertise in decision science, organizational behavior, and health services research. Dr. White is extremely well positioned to lead these efforts. He is a midcareer investigator with a mature, NIH-funded program of research on surrogate decision making in acute respiratory failure. He has an extensive track record of successful mentoring in patient-oriented research. He has assembled a team of senior scientists and collaborators to accomplish the proposed research and mentoring plan. He will increase his skills as a mentor and expand his scientific expertise by participating in targeted career development activities in mentoring, organizational science, and the psychology of group decision making. The scientific goal of this proposal is for Dr. White and his mentees to use the existing data and infrastructure of his ongoing R01s to develop new lines of research exploring the roles of interprofessional team functioning and group decision making on outcomes for incapacitated patients with acute respiratory failure. In Aim 1 the team will conduct a mixed methods study to characterize clinicians’ attitudes and actual practices related to interprofessional team collaboration in providing decision support to surrogates of patients with advanced respiratory failure (Aim 1a), then conduct exploratory analyses examining associations between team functioning and outcomes of patients with advanced respiratory failure (Aim 1b). In Aim 2 they will use the largest dataset in existence of audiorecorded clinician-family conferences about goals of care in ICUs to determine whether and how clinicians elicit the values and preferences of incapacitated patients from surrogates (Aim 2a), then conduct exploratory analyses examining associations with patient outcomes (Aim 2b). Together, these scientific aims and career development activities will expand Dr. White’s ability to train the next generation of patient-oriented researchers in developing interventions to improve surrogate decision making for patients with advanced respiratory failure.

抽象的 这项中级护理研究者奖的目标是以患者为导向的研究，以增强 道格拉斯·怀特（Douglas White）博士训练，心理和支持临床科学家的职业发展 开发和测试干预措施，以改善丧失能力患者的替代决策 晚期呼吸衰竭。急性呼吸衰竭和不良提示的患者经常接受 生命尽头的密集，朴素的治疗与其价值观不一致 偏好。这是一个重要的公共卫生问题，因为1）以患者为中心的护理 生活是道德，人类护理和2）生命尽头的过度治疗的核心方面 尽管范围 问题有充分的记录，几乎没有循证干预措施可以改善患者的预后。 解决此问题将需要科学家在决策科学方面的专业知识， 组织行为和卫生服务研究。怀特博士在领导的位置非常好 这些努力。他是一名中级研究员 急性呼吸衰竭的决策。他在成功的心理上有广泛的记录 面向患者的研究。他召集了一支由高级科学家和合作者组成的团队来完成 拟议的研究和心理计划。他将提高自己的精神技能，并扩大他的技能 科学专业知识通过参加有针对性的职业发展活动，组织，组织 科学和小组决策的心理学。该提议的科学目标是给怀特博士 以及他的Menees使用他正在进行的R01的现有数据和基础架构来开发新的线条 研究探讨跨专业团队功能和小组决策在 急性呼吸衰竭患者无行为能力的结果。在AIM 1中，团队将混合 方法研究以表征临床医生的参加和与专业团队有关的实际实践 合作在为患有晚期呼吸衰竭患者的替代物提供决策支持方面（AIM） 1A），然后进行探索性分析，以检查团队功能与结果之间的关联 患有晚期呼吸衰竭的患者（AIM 1B）。在AIM 2中，他们将使用最大的数据集 存在有关ICU中护理目标的审核记录的临床家庭会议的存在，以确定是否是否 以及临床医生如何引起替代患者无行为能力患者的价值和偏好（AIM 2A）， 然后进行探索性分析，以检查与患者结局的关联（AIM 2B）。一起， 这些科学目标和职业发展活动将扩大怀特博士培训下一个的能力 生成以患者为导向的研究人员制定干预措施以改善替代决定 为患有晚期呼吸衰竭的患者制造。

项目成果

Reply to Hick and Hanfling: Social Factors and Critical Care Triage: Right Intentions, Wrong Tools.

• DOI: 10.1164/rccm.202103-0798le
• 发表时间: 2021-07-15
• 期刊: American journal of respiratory and critical care medicine
• 影响因子: 24.7
• 作者: White DB;Lo B
• 通讯作者: Lo B

Weighted Lottery to Equitably Allocate Scarce Supply of COVID-19 Monoclonal Antibody.

• DOI: 10.1001/jamahealthforum.2023.2774
• 发表时间: 2023-09-01
• 期刊: JAMA HEALTH FORUM
• 作者: McCreary, Erin K.;Essien, Utibe R.;Chang, Chung-Chou H.;Butler, Rachel A.;Pathak, Parag;Soenmez, Tayfun;Uenver, M. Utku;Steiner, Ashley;Chrisman, Maddie;Angus, Derek C.;White, Douglas B.
• 通讯作者: White, Douglas B.

Rebuttal From Dr White et al.

• DOI: 10.1016/j.chest.2022.03.032
• 发表时间: 2022-07
• 期刊: CHEST
• 影响因子: 9.6
• 作者: White, Douglas B.;Lo, Bernard;Peek, Monica E.
• 通讯作者: Peek, Monica E.

Policies for Mandatory Ethics Consultations at U.S. Academic Teaching Hospitals: A Multisite Survey Study.

美国学术教学医院强制道德咨询政策：多地点调查研究。

• DOI: 10.1097/ccm.0000000000004343
• 发表时间: 2020
• 期刊: Critical care medicine
• 影响因子: 8.8
• 作者: Neal,JonathanB;Pearlman,RobertA;White,DouglasB;Tolchin,Benjamin;Sheth,KevinN;Bernat,JamesL;Hwang,DavidY
• 通讯作者: Hwang,DavidY

Association Between Shared Decision-Making During Family Meetings and Surrogates' Trust in Their ICU Physician.

家庭会议期间的共同决策与代理人对其 ICU 医生的信任之间的关联。

• DOI: 10.1016/j.chest.2022.10.028
• 发表时间: 2023
• 期刊: Chest
• 影响因子: 9.6
• 作者: Lincoln,TaylorE;Buddadhumaruk,Praewpannarai;Arnold,RobertM;Scheunemann,LeslieP;Ernecoff,NatalieC;Chang,Chung-ChouH;Carson,ShannonS;Hough,CatherineL;Curtis,JRandall;Anderson,Wendy;Steingrub,Jay;Peterson,MichaelW;Lo,Bernard
• 通讯作者: Lo,Bernard