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.

项目概要/摘要每年因心力衰竭 (HF) 相关住院的患者中，65 岁及以上的美国人占 70%，并且该人群中的许多人患有多种疾病、功能受限和高症状负担。作为HF 进展为晚期（纽约心脏协会 III-IV 级）疾病负担大幅增加，特别是在生命的最后 6 个月，80% 的人至少住院过一次，并且许多人都认可重大意义与功能衰退和无法参与生活角色和活动有关的痛苦。尽管广泛传播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益处这些服务在心力衰竭患者的生活中各不相同，而且没有得到充分利用。迄今为止，身体康复模型的设计并未同时解决复杂的心理社会问题和患有晚期心力衰竭的老年人的功能需求。为了优化这一弱势群体的生活质量，需要全面解决生物心理社会障碍的新康复策略。我的K23提案将通过开发和测试 LiveWell-HF（一种家庭物理治疗模型）来满足这一需求辅以早期综合姑息治疗的循证心理策略，以改善老年人因晚期心力衰竭住院后的应对和接受度。具体来说，我的目标是 1）开发初步的 LiveWell-HF 模型，包含提供者和患者利益相关者的意见； 2）使用细化LiveWell-HF 开放试点研究设计； 3) 评估改进后的 LiveWell-HF 模型的可行性、可接受性和保真度通过进行试点随机对照试验。这些目标的结果也将为 R01 功效试验提供信息未来的工作是确定 LiveWell-HF 对医疗保健利用率的影响以及模型的扩展为护理合作伙伴量身定制。该提案的目标将得到我的职业发展活动的支持，这些活动重点关注 1) 发展姑息治疗方面的先进临床和研究专业知识，2) 定性和混合开发和完善循证康复干预措施的方法研究，3) 临床试验研究， 4) 领导力发展。我的模范导师和顾问团队将由 Christine Ritchie 博士领导，国际知名的老年病学家和姑息治疗医生，拥有丰富的治疗经验针对严重疾病患者的混合方法研究和临床试验。我的互补专业知识导师和顾问，马萨诸塞州总医院和哈佛医学院丰富的机构环境学校和我的培养计划将使我能够顺利完成本次培训和研究目标应用。这个 K23 提案将为我提供开展职业生涯所需的技能和数据身体康复、姑息治疗和老年病学交叉领域的独立调查员和领导者心脏病学。最终，这一系列研究可以改善患有晚期心力衰竭的老年人的生活体验改变物理康复策略的设计方式，以满足患有严重疾病的老年人的需求疾病。