Enabling Older Adults to 'LiveWell' with Advanced Heart Failure: Development of a Palliative Rehabilitation Model

让患有晚期心力衰竭的老年人“活得更好”：姑息康复模型的开发

基本信息

批准号：
10663457
负责人：
Tamra J Keeney
金额：
$ 19.08万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-15 至 2028-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10663457
关键词：
Address Adoption Adult Advanced Malignant Neoplasm American Anxiety Award Awareness Benchmarking Cardiology Caring Chronic Clinical Clinical Trials Complex Data Development Disease Distress Effectiveness Elderly Environment Fatigue Focus Groups Fostering Future General Hospitals Goals Health Healthcare Heart failure Home Hospitalization Impairment Individual Institution International Intervention Interview Leadership Life Manuals Massachusetts Mentors Mentorship Methods Modeling New York Heart Association Class III/IV Outcome Pain Palliative Care Pathway interactions Patients Personal Satisfaction Phase Physical Rehabilitation Physical therapy Physicians Pilot Projects Population Positioning Attribute Program Acceptability Protocols documentation Provider Psychological Tests Qualitative Methods Quality of life Randomized Randomized, Controlled Trials Rehabilitation therapy Research Research Design Research Methodology Research Personnel Research Training Role Scientist Services Strategic Planning Structure Symptoms Testing Training Uncertainty United States United States National Institutes of Health Value of Life Vulnerable Populations Work acceptability and feasibility acute care age related aged biopsychosocial burden of illness care delivery care systems career career development clinical trial implementation coping cost design disability effective intervention efficacy trial evidence base experience functional decline functional improvement health care service utilization improved improved outcome intervention delivery intervention refinement leadership development medical schools model design mortality risk multiple chronic conditions novel palliative physical symptom prevent primary outcome prognostic programs psychologic psychological symptom psychosocial rehabilitation strategy rehabilitative care skills symptomatic improvement therapy development treatment as usual

项目摘要

PROJECT SUMMARY/ABSTRACT Americans aged 65 years and older account for 70% of heart failure (HF)-related hospitalizations each year, and many in this population are burdened by multimorbidity, functional limitations, and high symptom burden. As HF becomes advanced (New York Heart Association Class III-IV) disease burden increases substantially, especially in the last 6 months of life when 80% of individuals are hospitalized at least once and many endorse significant distress related to functional decline and inability to participate in life roles and activities. Despite widespread recognition of the distinct benefits of physical rehabilitation and palliative care in improving symptoms and quality of life among individuals with HF, these services are separate in their approach and underutilized. To date, physical rehabilitation models have not been designed to simultaneously address the complex psychosocial and functional needs of older adults with advanced HF. To optimize quality of life in this vulnerable population, a novel rehabilitation strategy that holistically addresses biopsychosocial impairments is needed. My K23 proposal will address this need by developing and testing LiveWell-HF, a home-based physical therapy model supplemented with evidence-based, psychological strategies from early integrated palliative care to improve coping and acceptance among older adults after hospitalization for advanced HF. Specifically, I aim to 1) develop the preliminary LiveWell-HF model with provider and patient stakeholder input; 2) refine LiveWell-HF using an open pilot study design; and 3) evaluate the feasibility, acceptability, and fidelity of the refined LiveWell-HF model by conducting a pilot randomized controlled trial. Findings from these aims will inform a R01 efficacy trial as well as future work to determine the impact of LiveWell-HF on healthcare utilization and an extension of the model tailored for care partners. The aims of this proposal will be supported by my career development activities, which focus on 1) developing advanced clinical and research expertise in palliative care, 2) qualitative and mixed methods research to develop and refine evidence-based rehabilitation interventions, 3) clinical trials research, and 4) leadership development. My exemplary team of mentors and advisors will be led by Dr. Christine Ritchie, an internationally renowned geriatrician and palliative care physician with extensive experience conducting mixed methods research and clinical trials in patients with serious illness. The complementary expertise of my mentors and advisors, rich institutional environment at Massachusetts General Hospital and Harvard Medical School, and my training plan will enable me to successfully complete the training and research aims in this application. This K23 proposal will provide me with the skills and data needed to launch my career as an independent investigator and leader at the intersection of physical rehabilitation, palliative care, and geriatric cardiology. Ultimately this line of research can improve the lived experience of older adults with advanced HF and change the way physical rehabilitation strategies are designed to meet the needs of older adults with serious illness.

项目摘要/摘要 65岁及以上的美国人每年占心力衰竭（HF）相关的70％该人群中的许多人受到多种病，功能限制和高症状负担的负担。作为HF 成为高级（纽约心脏协会III-IV）疾病负担大大增加，尤其是在生命的最后六个月中，80％的人至少住院一次，许多人认可重要与功能下降和无法参与生活角色和活动有关的困扰。尽管广泛认识到身体康复和姑息治疗在改善症状和质量方面的独特好处在患有HF的个体的生活中，这些服务的方法是分开的，并且没有充分利用。迄今为止，身体康复模型尚未设计用于同时解决复杂的心理社会和老年人患有晚期HF的功能需求。为了优化这个脆弱人群的生活质量，需要整体解决生物心理社会障碍的新型康复策略。我的K23提案将通过开发和测试Livewell-HF来满足这一需求，这是一种家庭物理疗法模型补充了早期综合姑息治疗的基于证据的心理策略，以改善住院后老年人的应对和接受。具体来说，我的目标是1）提供者和患者利益相关者投入的初步LiveWell-HF模型； 2）使用一个开放试点研究设计； 3）评估精致的LiveWell-HF模型的可行性，可接受性和保真度通过进行飞行员随机对照试验。这些目标的发现也将为R01功效试验提供信息随着未来的工作来确定Livewell-HF对医疗保健利用的影响和模型的扩展为护理伙伴量身定制。该提案的目的将得到我的职业发展活动的支持，专注于1）发展姑息治疗方面的先进临床和研究专业知识，2）定性和混合方法研究以开发和完善基于证据的康复干预措施，3）临床试验研究， 4）领导力发展。我的示范导师和顾问团队将由克里斯汀·里奇（Christine Ritchie）博士领导具有丰富经验的国际知名的老年医生和姑息治疗医师混合方法研究和严重疾病患者的临床试验。我的补充专业知识马萨诸塞州综合医院和哈佛医学的导师和顾问，丰富的机构环境学校，我的培训计划将使我能够成功完成培训和研究的目的应用。这个K23提案将为我提供启动我职业生涯所需的技能和数据身体康复，姑息治疗和老年医生的交叉点的独立研究员和领导者心脏病学。最终，这一研究可以改善高级HF老年人的生活经验并改变身体康复策略的方式，以满足认真的老年人的需求疾病。