Communication in the Hospital: Impact on the Patient and Surrogate

医院中的沟通：对患者和代理人的影响

• 批准号: 9162147
• 负责人: Alexia Mary Torke
• 金额: $ 16.7万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-15 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9162147
• 关键词: Address; Adult; Age; Aging; Alexia; Amber; Anxiety; Appointment; Area; Award; Belief; Caring; Cessation of life; Clinical Sciences; Code; Communication; Communities; Data; Data Set; Databases; Decision Making; Delirium; Dementia; Development; Dimensions; Distress; Doctor of Philosophy; Education; Educational process of instructing; Educational workshop; Elderly; Emotional; Enrollment; Ethics; Face; Faculty; Family; Family member; Fellowship; Foundations; Frail Elderly; Frail Older Adults; Funding; Future; Goals; Grant; Health; Health Communication; Health Professional; Healthcare; Hospitalization; Hospitals; Impaired cognition; Indiana; Institutes; Intervention Studies; K-Series Research Career Programs; Knowledge; Lead; Leadership; Life; Location; Measures; Medical; Medical Ethics; Mental Depression; Mentors; Mentorship; Mid-Career Clinical Scientist Award (K24); National Institute on Aging; Observational Study; Outcome; Palliative Care; Patient Care; Patient-Focused Outcomes; Patients; Personal Satisfaction; Physicians; Population; Positioning Attribute; Primary Health Care; Religion; Religion and Spirituality; Reporting; Research; Research Infrastructure; Research Personnel; Research Training; Resources; Risk; Role; Scholarship; Scientist; Source; Spouses; Stress; Surveys; Time; Training; Translational Research; United States National Institutes of Health; Universities; Ventilator; Work; base; career; clinical investigation; clinical practice; emotional distress; end of life; experience; graduate student; improved; mid-career faculty; next generation; patient oriented; patient oriented research; post-traumatic stress; preference; professor; programs; psychological outcomes; skills; study characteristics; surrogate decision maker; therapy development

Vulnerable older adults and their families face multiple challenges in medical decision making, health communication, and the emotional distress involved in facing serious illness and death. Dr. Alexia Torke's research has focused on the communication, ethical, religious and spiritual aspects of decision making for those patients who are incapacitated and require a family surrogate to make decisions for them. This K24 award will provide support for Dr. Torke's program of research and will allow her additional protected time to pursue her passion for mentoring others. The specific aims of this K24 award are to: train future aging researchers to conduct high quality research focused on decision making and outcomes for vulnerable older adults and their family members; to study the experience of family surrogate decision makers, including the impact of communication quality on decision quality and family outcomes such as anxiety, depression, and posttraumatic stress; and to measure surrogates' religious and spiritual experiences to determine whether these factors are associated with medical decision making and the medical care that patients receive at the end of life. Dr. Torke' research topic is important because nearly half of hospitalized older adults are unable to make their own medical decisions and require a family member or other surrogate to make decisions for them. Her prior research has shown that many surrogates make decisions about life and death issues under conditions of high stress and often with poor support from clinicians. Surrogates rely on various sources of emotional support and sources of value to make medical decisions, including personal, religious and spiritual beliefs. However, both surrogates and clinicians report high levels of distress due to the emotional and communication challenges of making decisions for others. Although there is evidence from patient studies that religion is associated with preferences for more aggressive care at the end of life, this has not been studied for surrogates making decisions for others. As the population ages and a greater number of older adults are at risk for cognitive impairment, the importance of surrogate decision making will only increase. Understanding the mechanisms underlying high quality decision making will allow us to best support family members and to provide the best possible care to older adults. The projects proposed in this award will leverage a database of 359 older hospitalized adults and their surrogate decision makers that Dr. Torke has developed through funding from an R01 grant from the National Institute on Aging. Additional funding from the Indiana University Health Values Grant and the Greenwall Foundation allowed Dr. Torke to also collect data on the goals of care endorsed by the surrogate, care received at the end of life, and the religious and spiritual experiences of the surrogates. Project 1 will explore the impact of communication quality on decision making quality and surrogate well-being, such as posttraumatic stress. Project 2 will examine the religious and spiritual dimensions of the surrogates and will study whether these impact medical decision making as well as the actual care received by the 40% of our enrolled patients who died within the 6-month study observation period. The findings from these projects will inform the development of interventions to improve both the quality of medical care for incapacitated patients and the well-being of their family members. Dr. Torke is a tenured Associate Professor at Indiana University. Her clinical practice has involved palliative care and primary care for older, frail adults. She has mentored over 16 fellows, residents, graduate students and junior faculty in research related to medical decision making, communication and health outcomes for older adults. Her leadership roles at Indiana University, including her appointment as Associate Director of the IU Center for Aging Research (IUCAR), put her in a position to mentor early career investigators focused on patient oriented research. This award will provide her with protected time to further develop her own research program and expand the scope of her mentoring activities. Indiana University provides an ideal location for this work. Dr. Torke's primary appointment is in IUCAR, where there are 10 investigators conducting aging research. The institute has provided infrastructure, intramural funding and space for Dr. Torke's research. She is taking on increasing responsibilities in the mentorship of research fellows and junior faculty. Through leadership roles at IU Health, Dr. Torke mentors a chaplain researcher and has mentored numerous ethics fellows, including physicians and PhD-prepared scientists who are embarking on research careers. Additional resources such as the Indiana Clinical and Translational Sciences Institute (CTSI) enrich opportunities for mentees to obtain research training through the Clinical Investigation and Translational Education (CITE) program and funding support through the KL2 career development awards.

弱势老年人及其家人在医疗决策、健康方面面临多重挑战 沟通，以及面对严重疾病和死亡所带来的情绪困扰。亚历克西娅·托克博士的 研究重点是决策的沟通、伦理、宗教和精神方面 那些丧失行为能力并需要家庭代理人为他们做出决定的患者。这个K24 该奖项将为托克博士的研究计划提供支持，并让她有额外的受保护时间 追求她指导他人的热情。 该 K24 奖项的具体目标是： 培训未来的老龄化研究人员进行高质量的研究 重点关注弱势老年人及其家庭成员的决策和结果；研究 家庭代理决策者的经验，包括沟通质量对决策的影响 质量和家庭结果，例如焦虑、抑郁和创伤后压力；并测量 代理人的宗教和精神经历，以确定这些因素是否与医疗有关 患者临终时接受的决策和医疗护理。 托克博士的研究课题很重要，因为近一半住院的老年人无法恢复正常生活。 自己做出医疗决定，并要求家庭成员或其他代理人为他们做出决定。她之前的 研究表明，许多代孕妈妈是在高压条件下做出生死问题的决定的。 压力大，而且往往得不到临床医生的支持。代理人依赖各种来源的情感支持和 做出医疗决策的价值来源，包括个人、宗教和精神信仰。然而，两者 代孕妈妈和临床医生报告称，由于代孕妈妈的情绪和沟通方面的挑战，他们感到非常痛苦。 为他人做决定。尽管有来自患者研究的证据表明宗教与 偏好在临终时采取更积极的护理，这尚未针对代孕母亲进行研究 为他人做出决定。随着人口老龄化，越来越多的老年人面临认知风险 损害，替代决策的重要性只会增加。了解机制 潜在的高质量决策将使我们能够最好地支持家庭成员并提供最好的服务 为老年人提供可能的护理。 该奖项提出的项目将利用包含 359 名住院老年人及其家人的数据库 Torke 博士通过国家 R01 拨款资助开发的代理决策者 老龄化研究所。来自印第安纳大学健康价值补助金和 Greenwall 的额外资助 基金会还允许托克博士收集有关代孕妈妈认可的护理目标的数据，护理 在生命结束时收到的信息，以及代理人的宗教和精神经历。项目1将探索 沟通质量对决策质量和替代者福祉的影响，例如 创伤后应激障碍。项目 2 将检查代孕者的宗教和精神层面，并将 研究这些是否会影响医疗决策以及 40% 的人接受的实际护理 纳入在 6 个月研究观察期内死亡的患者。这些项目的研究结果将 为制定干预措施提供信息，以提高无行为能力患者的医疗护理质量 以及他们家人的福祉。 托克博士是印第安纳大学的终身副教授。她的临床实践涉及姑息治疗 为年老体弱的成年人提供护理和初级护理。她指导了超过 16 名研究员、住院医生、研究生 以及从事与医疗决策、沟通和健康结果相关研究的初级教师 老年人。她在印第安纳大学担任领导职务，包括被任命为该大学的副主任 印第安纳大学老龄化研究中心 (IUCAR)，让她能够指导早期职业研究人员专注于 以患者为导向的研究。该奖项将为她提供受保护的时间来进一步发展自己的研究 计划并扩大她的指导活动范围。 印第安纳大学为这项工作提供了理想的场所。 Torke 博士的主要任命是在 IUCAR，在那里 有10名研究人员进行衰老研究。该研究所提供了基础设施、校内 托克博士研究的资金和空间。她在指导方面承担着越来越多的责任 研究员和初级教师。通过在印第安纳大学健康中心担任领导职务，托克博士指导了一名牧师 研究员，并指导了许多伦理研究员，包括医生和博士准备的科学家 正在开始研究生涯。其他资源，例如印第安纳州临床和转化 科学研究所 (CTSI) 为学员​​提供丰富的机会，通过临床培训获得研究培训 调查和转化教育 (CITE) 计划以及通过 KL2 职业提供的资金支持 发展奖。