I CAN DO Surgical ACP (Improving Completion, Accuracy, and Dissemination Of Surgical Advanced Care Planning) Trial

I CAN DO Surgical ACP（提高外科高级护理计划的完成度、准确性和传播）试验

• 批准号: 10649843
• 负责人: Genevieve B Melton-Meaux
• 金额: $ 69.88万
• 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: 2023-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10649843
• 关键词: Adoption; Advance Care Planning; Advance Directives; Articulation; Biometry; Caregivers; Caring; Cessation of life; Clinic; Clinical; Clinical Trials; Collaborations; Colonoscopy; Communication; Complex; Data Science; Decision Making; Dedications; Documentation; Effectiveness; Elderly; Elective Surgical Procedures; Electronic Health Record; Ensure; Evaluation; Familiarity; Foundations; Geography; Geriatrics; Goals; Guidelines; Health; Health Services; Health Status; Health behavior; Health system; Healthcare; Healthcare Systems; Home; Human; Impairment; Individual; Informatics; Infrastructure; Intervention; Letters; Mammography; Measures; Medical; Methods; Modality; Modeling; Natural Language Processing; Operative Surgical Procedures; Outcome; Outcome Measure; Patient Care Planning; Patients; Persons; Phase; Physicians; Population; Preparation; Randomized; Randomized, Controlled Trials; Reporting; Research; Resources; San Francisco; Societies; Surgeon; Surveys; System; Technology; Telephone; Testing; Text; Time; Training; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Work; aged; arm; care episode; data mining; design; digital intervention; digital tool; effectiveness evaluation; empowerment; end of life; evidence base; experience; functional disability; handheld mobile device; implementation science; improved; innovation; medical schools; novel; patient engagement; patient oriented; patient portal; pilot test; preference; primary outcome; programs; remote health care; surrogate decision maker; theories; tool; virtual healthcare; web site

Project Summary Nearly 20 million older adults undergo major elective surgical procedures, yet very few receive advance care planning (ACP). This is a critical missed opportunity to ensure optimal and patient-aligned medical decisions and communications. Despite ACP being incorporated into national quality metrics and society guidelines for surgical care for older adults, there are few examples of effective integration into the pre-surgical phase. Efforts to date have mostly focused on improving surgeons’ use of ACP but barriers remain significant, including varying levels of familiarity and comfort to conduct ACP conversations, lack of dedicated time during the pre-surgical care episode for these often-delicate conversations, and lack of appropriate patient-facing ACP tools to help patients and caregivers make complex decisions about their surgical treatment. Our team has designed and tested a theory-based, interactive ACP patient-facing technology solution (PREPARE) based on the new ACP paradigm of preparing people for communication and medical decision-making. Despite consistent evidence that PREPARE increases ACP engagement and patient and clinician empowerment to discuss ACP, a gap remains in extending PREPARE’s use to pre-surgical populations. We hypothesize that by including PREPARE into the electronic health record (HER)-centric pre-surgery workflow for older adults and including automated reminders, we can empower patients and surgical teams to engage in ACP discussions. Given the limited time and resources in the surgical setting to conduct ACP, we will be testing 3 delivery strategies in increasing resource intensity (PREPARE alone, PREPARE with text/phone reminders, or the additional of a healthcare navigator). To ensure generalizability, we will conduct our work in 3 healthcare systems (HCS): Univ. of CA, San Francisco (UCSF), Univ. of CA, Irvine (UCI) and M Health Fairview (UMN, a collaboration among the Univ. of MN Medical School, Univ of MN Physicians, and Fairview Health Services). We will first establish trial infrastructure (UG3) to conduct (UH3) an NIH Stage Model III (efficacy-effectiveness) three arm RCT in 3 HCS. Patients aged 65 or older, or with serious illness, who are referred for major elective surgery will be randomized to Arms: (1) Letter about ACP, PREPARE advanced directive (AD), PREPARE website; (2) Letter, AD, PREPARE plus reminder text/phone messages; (3) Letter, AD, PREPARE plus reminders plus a healthcare navigator on ACP documentation (discussions and care plans, primary outcome) and patient-reported ACP engagement. Using mixed methods, we will assess patients’ and surgical care teams' experience with surgery ACP. ACP note content will be evaluated using natural language processing (NLP) and data mining to begin to identify assess thematic completeness of ACP notes. This work is innovative because we are coalescing existing collaborations between HCS into a transdisciplinary group of surgeons, geriatricians, and informaticians across three health systems that will develop infrastructure and rigorously test a novel patient-centered system-level approach to integrating ACP into the surgical care episode, the first step towards goal-concordant surgical care.

项目摘要 近2000万老年人接受了重大的选修手术程序，但很少有人接受预先护理 计划（ACP）。这是一个关键的错失机会，以确保最佳和患者一致的医疗决策和 通讯。尽管ACP被纳入国家质量指标和社会指南中的手术指南 照顾老年人，几乎没有有效整合到外科阶段的例子。迄今为止的努力 主要专注于改善外科医生对ACP的使用，但障碍仍然很大，包括不同的水平 进行ACP对话的熟悉和舒适性，外科护理期间缺乏专用时间 这些经常悬而未决的对话的发作，以及缺乏适当的面向患者的ACP工具来帮助患者 护理人员就其手术治疗做出了复杂的决定。我们的团队设计和测试了 基于理论的，交互式ACP患者面向患者的技术解决方案（准备）基于新的ACP范式 为人们准备沟通和医疗决策。尽管有证据表明 准备增加ACP参与度以及患者和临床授权以讨论ACP，差距仍然存在 在扩展准备前手术前的人群中。我们假设将准备准备 电子健康记录（HER） - 针对老年人的中心术前工作流程，包括自动提醒， 我们可以使患者和外科团队有能力进行ACP讨论。鉴于有限的时间， 在手术环境中进行ACP的资源，我们将测试3种交付策略，以增加资源 强度（独自准备，使用文本/电话提醒或医疗保健导航器的附加功能）。 为了确保概括性，我们将在3个医疗保健系统（HCS）中进行工作：Univ。 CA，旧金山 （UCSF），大学。 CA，Irvine（UCI）和M Health Fairview（UMN，Mn Medical的合作 学校，MN医师大学和Fairview Health Services）。我们将首先建立试验基础设施（UG3） 进行（UH3）NIH阶段III型（有效性）3 HC中的三个ARM RCT。年龄65岁或 年龄较大，或患有严重疾病的人被转诊为大型选修手术将被随机分配给武器：（1）信件 关于ACP，准备高级指令（AD），准备网站； （2）字母，广告，准备加上提醒 文字/电话消息； （3）字母，广告，准备加上提醒以及ACP上的医疗保健导航员 文档（讨论和护理计划，主要结果）和患者报告的ACP参与度。使用 混合方法，我们将评估患者和外科护理团队在ACP中的经验。 ACP注释 内容将使用自然语言处理（NLP）和数据挖掘来评估内容以开始识别评估 ACP注释的主题完整性。这项工作具有创新性，因为我们正在融合现有的合作 在三名健康状况的HC之间，将HC分成一个跨学科的外科医生，老年医生和信息能力 将开发基础架构并严格测试新型以患者为中心的系统级方法的系统 将ACP整合到手术护理剧集中，这是迈向目标手术护理的第一步。