Improving Advance Care Planning by Preparing Diverse Seniors for Decision Making

通过帮助不同的老年人做好决策来改善预先护理计划

基本信息

批准号：
8850779
负责人：
REBECCA L SUDORE
金额：
$ 58.51万
依托单位：
NORTHERN CALIFORNIA INSTITUTE/RES/EDU
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-01 至 2016-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8850779
关键词：
Address Advance Care Planning Advance Directives Affect Attitude Behavior Behavioral Caring Chronic Chronic Disease Clinic Visits Clinical Communication Complex Decision Making Disease Double-Blind Method Educational process of instructing Elderly Ethnic Origin Face Focus Groups Future General Hospitals Goals Health Individual Intervention Lead Life Linear Models Malignant Neoplasms Measures Mechanical ventilation Medical Methods Minority Modeling Nurses Office Visits Outcome Patient Outcomes Assessments Patient Self-Report Patients Physicians Population Heterogeneity Preparation Primary Health Care Procedures Public Health Race Randomized Reading Reporting Research Research Personnel San Francisco Self Efficacy Social Workers Specific qualifier value Stress Subgroup Surveys Techniques Testing Time United States National Institutes of Health Work aged arm base cohort cost design efficacy testing efficacy trial empowerment end of life fifth grade health literacy improved literacy loved ones novel older patient patient oriented preference safety net satisfaction surrogate decision maker theories web site

项目摘要

DESCRIPTION (provided by applicant): Millions of diverse, older adults and their surrogate decision makers will face many complex, ongoing decisions over the course of chronic and advanced illness. Preparation for decision is making or advance care planning (ACP), has traditionally focused on making decisions about life-prolonging procedures (e.g., mechanical ventilation) by completing advance directives. Yet, advance directives often fail to prepare patients to identify their values or to communicate with surrogates and clinicians. Therefore, the research team developed a broader paradigm of ACP that focuses instead on preparing patients to communicate their wishes and to participate with clinicians in making real-time, complex medical decisions over the course of illness. The research team has created an easy-to-understand, patient-centered website called PREPARE that is based on this new ACP paradigm. PREPARE teaches patients, through videos and modeling of ACP behaviors, how to identify their wishes and communicate with surrogates and clinicians. The objective of this proposal is to test PREPARE in a double-blind, randomized, efficacy trial. The aims of this study are: (1) to determine the efficacy of PREPARE to engage ethnically diverse, older adults in a range of ACP behaviors (i.e., identify and discuss wishes with surrogates and clinicians as well as complete advance directives), and (2) to assess whether the efficacy of PREPARE varies by patient subgroups, such as race/ethnicity and literacy level. The researchers will also obtain input from patients, surrogates, and clinicians about implementation of PREPARE in safety-net settings. Methods: 500 patients aged e 55 years with chronic illness from San Francisco General Hospital will be randomly assigned to either the intervention arm (PREPARE plus an advance directive) or the control arm (advance directive only). Main outcomes of patient- reported engagement in ACP will be measured with validated surveys at 1 week, 3, 6, and 12 months (Aim 1). We will use mixed-effects generalized linear models to assess differences in longitudinal outcomes between arms and control for variables that differ between arms. We will also adjust for clustering by clinician. To assess efficacy by patient subgroups, we will include interaction terms of race/ethnicity and literacy by study arm in the modeling (Aim 2). Relevance to NIH and public health: If PREPARE is efficacious, the researchers will have a novel, practical, scalable ACP guide that will be easy to use and disseminate within diverse populations. This will result in diverse, older adults who are prepared to communicate their wishes and make complex medical decisions over the course of serious and chronic illness.

描述（由申请人提供）：数以百万计的多元化老年人及其代理决策者将在慢性和晚期疾病过程中面临许多复杂的、持续的决策。决策准备是制定或预先护理计划 (ACP)，传统上侧重于通过完成预先指示来做出有关延长生命的程序（例如机械通气）的决策。然而，预先指示往往无法让患者做好准备，识别自己的价值观或与代理人和临床医生进行沟通。因此，研究团队开发了更广泛的 ACP 范式，重点是让患者做好沟通意愿的准备，并与临床医生一起在病程中做出实时、复杂的医疗决策。研究团队基于这种新的 ACP 范式创建了一个易于理解、以患者为中心的网站，名为 PREPARE。 PREPARE 通过视频和 ACP 行为建模，教导患者如何确定自己的意愿并与代理人和临床医生沟通。该提案的目的是在双盲、随机、功效试验中测试 PREPARE。本研究的目的是：(1) 确定 PREPARE 的功效，让不同种族的老年人参与一系列 ACP 行为（即与代理人和临床医生确定并讨论愿望以及完成预先指示），以及（ 2) 评估 PREPARE 的疗效是否因患者亚组（例如种族/民族和识字水平）而异。研究人员还将获得患者、代理人和临床医生关于在安全网环境中实施 PREPARE 的意见。方法：来自旧金山综合医院的 500 名年龄在 55 岁左右的慢性病患者将被随机分配到干预组（PREPARE 加预先指示）或对照组（仅预先指示）。患者报告的 ACP 参与度的主要结果将通过 1 周、3、6 和 12 个月时经过验证的调查来衡量（目标 1）。我们将使用混合效应广义线性模型来评估各组之间纵向结果的差异，并控制各组之间不同的变量。我们还将根据临床医生的聚类进行调整。为了评估患者亚组的疗效，我们将在模型中按研究组纳入种族/族裔和识字率的相互作用项（目标 2）。与 NIH 和公共卫生的相关性：如果 PREPARE 有效，研究人员将拥有新颖、实用、可扩展的 ACP 指南，该指南将易于在不同人群中使用和传播。这将导致多样化的老年人准备好表达自己的愿望，并在严重和慢性疾病的过程中做出复杂的医疗决定。