Personalized End of Life Care in Safety-Net hospitals: Implementation of the 3 Wishes Project

安全网医院的个性化临终关怀：实施“三个愿望”项目

• 批准号: 10736466
• 负责人: THANH H NEVILLE
• 金额: $ 54.4万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-17 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10736466
• 关键词: Address; Adoption; Bereavement; Budgets; Caring; Cessation of life; Clinical; Collaborations; Compassion; Consolidated Framework for Implementation Research; County; Critical Illness; Data; Direct Costs; Disadvantaged; Distress; Effectiveness; Elements; Emotional; Empathy; Evaluation; Family; Family member; Foundations; Grief reaction; Health; Health Services; Health Services Accessibility; Healthcare; Hospitalization; Hospitals; Inequity; Intensive Care Units; Intervention; Interview; Job Satisfaction; Language; Leadership; Life Experience; Limited English Proficiency; Los Angeles; Low income; Measurement; Measures; Medical; Medicine; Mental Depression; Methods; Modeling; Multi-Institutional Clinical Trial; Music; Nurses; Palliative Care; Patient-Centered Care; Patients; Patients' Rooms; Perception; Physicians; Play; Population; Post-Traumatic Stress Disorders; Public Hospitals; Qualitative Research; Quality of life; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Research Design; Resource-limited setting; Resources; Sampling; Scientist; Services; Spirituality; Structure; Survey Methodology; Surveys; System; Thinness; Training; Uninsured; Variant; Work; advanced disease; burnout; coping; cost; design; distrust; effectiveness/implementation study; empowerment; end of life; end of life care; experience; health care settings; implementation barriers; implementation outcomes; implementation process; implementation science; implementation strategy; implementation/effectiveness; improved; innovation; loved ones; low health literacy; neglect; novel; patient oriented; patient population; primary outcome; psychological symptom; safety net; satisfaction; secondary outcome; structural determinants; tool; treatment as usual

Project Summary Compassionate end-of-life (EOL) care is foundational to medicine, but providing patients and families in safety-net hospitals (SNHs) with the sense that they are physically and emotionally supported during a patient’s terminal hospitalization can be challenging. SNHs are public hospitals that primarily provide services to low-income and uninsured patients on a minimal budget. Although high quality EOL care is an important unmet need in SNHs, its provision is fraught with barriers and challenges. Language barriers, low health literacy, and cultural differences can make it difficult for families in SNHs to perceive empathy and support during the EOL. Deaths in the intensive care unit (ICU) for underserved families can be traumatic, and families of patients who die in the ICU often suffer from depression and post-traumatic stress disorder. Palliative care interventions are needed, but implementation is often resource-prohibitive. The 3 Wishes Project (3WP) is a palliative care intervention that aims to achieve a dignified and compassionate EOL experience by empowering the clinical team to elicit and fulfill small wishes for critically ill patients who are dying in the ICU. Although the 3WP has been shown to improve a family’s experience of their loved one’s EOL care, ease bereavement, and enhance clinician work satisfaction in academic centers, it has not been implemented and evaluated in low-resource hospitals. We believe that this patient-centered and clinician-partnered initiative can improve the EOL experience in SNHs, but that it must be adapted to the contextual differences and needs of low-resource hospitals. We propose to obtain and use stakeholder input to customize a multi-component 3WP Toolkit that will facilitate 3WP implementation in SNHs. Using the tailored Toolkit, we will implement and evaluate the 3WP in the three SNHs of the Los Angeles County Department of Health Services. We will conduct a pragmatic type 2 hybrid effectiveness-implementation study to evaluate the quality of EOL ICU care, bereaved families’ psychological symptoms, and clinician burnout as compared to usual care. We will use the Consolidated Framework for Implementation Research (CFIR) and the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to guide a mixed-methods evaluation of the 3WP implementation in SNHs. Our team of clinicians and scientists have collaborated previously and have expertise in EOL care, implementation science, qualitative research, research in the safety-net system, and 3WP implementation. We hypothesize that our novel effectiveness-implementation approach will demonstrate that the 3WP addresses key gaps in palliative care in SNHs, which have historically had less ability to implement novel interventions. The results of this study will provide a roadmap to implement interventions in SNHs and lay the foundation for broader dissemination, adoption, and sustainment of the 3WP in diverse healthcare settings.

项目摘要 富有同情心的寿命（EOL）护理是医学的基础，但为患者和家庭提供 安全网络医院（SNHS）的感觉是，它们在身体和情感上得到了支持 患者的终末住院治疗可能会受到挑战。 SNH是主要提供服务的公立医院 预算最少的低收入和无保险患者。尽管高质量的EOL护理是重要的 在SNHS中，其规定未满足，充满了障碍和挑战。语言障碍，健康状况不佳 识字和文化差异可以使SNH的家庭很难感知同理心和支持 在EOL期间。重症监护病房（ICU）的死亡人数不足的家庭可能是创伤的，家庭 在ICU中死亡的患者通常患有抑郁症和创伤后应激障碍。姑息治疗 需要干预措施，但实施通常是资源过滤的。 3个愿望项目（3WP）是一种姑息治疗干预措施，旨在实现衍生品和 通过赋予临床团队的能力来激发和满足重病的小愿望，来富有同情心的EOL经验 死于ICU的患者。尽管已证明3WP可以改善家庭的经验 亲人的EOL护理，轻松丧亲并提高学术中心的临床工作满意度，它具有 未在低资源医院实施和评估。我们认为，以患者为中心的 临床合作的计划可以改善SNH中的EOL体验，但必须适应 低资源医院的上下文差异和需求。 我们建议获取并使用利益相关者输入来自定义多组件3WP工具包 促进SNHS中的3WP实施。使用量身定制的工具包，我们将在 洛杉矶县卫生服务部的三个SNH。我们将进行务实的2型 混合有效性实施研究以评估EOL ICU护理的质量，死去的家庭 与通常的护理相比，心理症状和临床倦怠。我们将使用合并的 实施研究框架（CFIR）和RE-AIM（覆盖，有效性，采用， 实施和维护）指导3WP的混合方法评估的框架 在SNHS中实现。 我们的临床医生和科学家团队以前曾合作过，并在EOL护理方面拥有专业知识， 实施科学，定性研究，安全网系统的研究和3WP实施。我们 假设我们新颖的有效性实践方法将证明3WP地址 SNHS姑息治疗的关键差距，历史上具有较少的实施新干预的能力。 这项研究的结果将为实施SNH的干预措施提供路线图，并为 在潜水员医疗机构中，3WP的更广泛的传播，采用和维持。