VET-Spirit: A Pilot Feasibility and Acceptability Trial to Address Spiritual Needs in Seriously-Ill Veterans

VET-Spirit：一项旨在满足重病退伍军人精神需求的试点可行性和可接受性试验

• 批准号: 10538926
• 负责人: Karen E Steinhauser
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10538926
• 关键词: Accountability; Address; Affect; Agreement; Belief; Cardiology; Caring; Chaplain; Chronic Obstructive Pulmonary Disease; Clinical; Communication; Complex; Congestive Heart Failure; Data; Decision Making; Development; Eligibility Determination; Enrollment; Ensure; Evaluation; Family member; Focus Groups; Frequencies; Funding; Future; Goals; Health Care Costs; Health Personnel; Healthcare; Hybrids; Intervention; Interview; Knowledge; Life; Link; Location; Malignant Neoplasms; Measures; Medical; Mental Health; Methodology; Methods; Modeling; Motivation; Oncology; Outcome; Pain management; Palliative Care; Participant; Patient Care; Patient-Centered Care; Patients; Personal Satisfaction; Physicians; Process; Provider; Psychometrics; Qualitative Methods; Quality of life; Religion and Spirituality; Reporting; Research; Research Personnel; Resources; Sampling; Screening procedure; Self Efficacy; Spiritual care; Spirituality; Stream; Validation; Veterans; Visit; Voice; Work; acceptability and feasibility; care coordination; care delivery; care preference; clinical care; clinical practice; coping; design; effectiveness/implementation trial; end of life; experience; follow-up; health care service organization; implementation measures; implementation strategy; improved; innovation; member; palliative; patient response; physical symptom; pilot test; preference; provider communication; response; satisfaction; screening; statistics; symptom management; tool; trend

Background: Seriously-ill veterans rely on spiritual and existential beliefs to cope with their illness, support their quality of life, and make critical healthcare decisions. As a result, VHA (Directive 1111) and other major health care organizations mandate spiritual assessments. With VA funding, our research team developed and validated the first quantifiable spiritual screening tool designed specifically for seriously-ill Veterans, VET-Spirit. The crucial next step is integrating screening and response to spiritual needs into serious illness care. This proposal develops and evaluates the feasibility and acceptability of implementing VET-Spirit, which systematically measures spiritual needs and subsequently equips providers with spiritual needs data into clinical care. VET-Spirit includes a curated summary of VET-Spirit patient response data to providers with communication prompts to aid in discussions of unmet needs. We hypothesize: 80% of veteran enrollees will complete VET-Spirit measure; 75% of providers rate AIM, FIM and IAM items at a mean of four or above on a five-point likert scale indicating agreement with acceptability, feasibility and appropriateness of the implementation strategy. Significance/ Impact: While the VHA mandates spiritual care, VA’s use neither a common: 1) screening tool, or 2) process for integrating identified needs into care. VET-Spirit includes both. Innovation: 1) Ensuring Compliance - No previous intervention has been designed to assess the spiritual needs and resources of seriously-ill veterans, curate that information, and deliver it to the care team. Integrating an actionable spiritual screening tool into the stream of care enhances care coordination and places the VA at the forefront of care of seriously-ill veterans. 2) Spiritual Care Accountability - VET-Spirit creates and evaluates a process for patient-centered care by integrating screening of spiritual beliefs into serious illness decision-making. 3) Whole Patient Care – VET-Spirit serves as a model for integrating patient voices into care. Specific Aims: Aim 1) Identify what and how providers (physicians, palliative care and POSH teams, chaplains) want to receive data on Veterans’ spirital needs. Determine content, format, barriers and facilitators to spiritual needs information delivery and its integration into care. Aim 2) Evaluate the feasibility and acceptability of VET-Spirit among providers of seriously-ill veterans (e.g. stage IV cancer, congestive heart failure, chronic obstructive pulmonary disease). Methodology: Aim 1 - qualitative methods of focus groups and in-depth interviews and directed content analyses of those data will inform: work flow considerations, information delivery location, content, format, conversation prompts, additional facilitators and barriers, and provider self-efficacy. Aim 2 - qualitative and quantitative methods to determine VET-Spirit feasibility and acceptability. Descriptive statistics will be calculated for all quantitative measures as well as trend change scores in outcomes (e.g., provider self-efficacy, knoweldge). Acceptabiltiy and feasiblity measures include: rates of VET-Spirit provider participation, veteran participants accrued, enrolled and retained, number of VET-Spirit completions, number of chaplain referrals and visits, acceptability if implementation measure (AIM), feasibility of implementation measure (FIM) and implementation appropriateness measure (IAM) scores; and provider satisfaction with tool ease, efficiency and self-efficacy in spiritual care communications (assessed qualitatively). Next Steps: Results of this pilot will fill the datagap in spiritual care delivery and inform a large scale Hybrid Type 1 Effectiveness-Implementation Trial of VET-Spirit.

背景：身患重病的退伍军人依靠精神和存在信念来应对他们的生活 疾病、支持他们的生活质量并做出重要的医疗保健决策。 （指令 1111）和其他主要医疗保健组织强制要求进行精神评估。 在退伍军人管理局的资助下，我们的研究团队开发并验证了第一个可量化的精神筛查 专为重病退伍军人设计的工具 VET-Spirit 下一步关键是整合。 该提案的制定和对精神需求的响应纳入了严重疾病护理。 评估实施 VET-Spirit 的可行性和可接受性，系统地 衡量精神需求，随后为提供者提供精神需求数据 VET-Spirit 包括 VET-Spirit 患者反应数据的汇总摘要。 提供沟通提示的提供者可以帮助讨论未满足的需求。 80% 的退伍军人参与者将完成 VET-Spirit 测量；75% 的提供商评价 AIM、FIM 和 IAM 项目在五点李克特量表上平均为四分或以上，表明同意 实施策略的可接受性、可行性和适当性。 影响：虽然 VHA 强制要求精神护理，但 VA 并没有使用通用的：1）筛查工具， 或 2) 将已确定的需求纳入护理的流程包括两者。 确保遵守 - 之前没有设计任何干预措施来评估精神 重病退伍军人的需求和资源，整理该信息并将其提供给护理人员 将可行的精神筛查工具整合到护理流程中可以增强护理效果。 协调并使退伍军人管理局处于照顾重病退伍军人的最前沿 2) 精神关怀。 问责制 - VET-Spirit 通过以下方式创建和评估以患者为中心的护理流程： 3) 整个病人 护理 – VET-Spirit 是将患者的声音融入护理的模型： 目标 1) 确定提供者的内容和方式（医生、姑息治疗和 POSH 团队、牧师） 希望接收有关退伍军人精神需求的数据，确定内容、格式、障碍和。 精神需求信息传递及其融入护理的促进者 目标 2) 评估。 VET-Spirit 在重病退伍军人提供者中的可行性和可接受性（例如 IV 癌症、充血性心力衰竭、慢性阻塞性肺病）方法：目标。 1 - 焦点小组和深度访谈的定性方法以及定向内容分析 这些数据将告知：工作流程注意事项、信息传递位置、内容、格式、 对话提示、额外的促进因素和障碍以及提供者的自我效能目标 2 - 确定 VET-Spirit 可行性和可接受性的定性和定量方法。 将计算所有定量指标以及趋势变化的描述性统计数据 结果得分（例如，提供者的自我效能、知识）。 措施包括：VET-Spirit 提供者的参与率、退伍军人参与者的累积率、 注册和保留、完成 VET-Spirit 的数量、牧师转介和访问的数量、 实施措施的可接受性（AIM）、实施措施的可行性（FIM）和 实施适当性衡量（IAM）分数和提供商对工具易用性的满意度； 精神关怀沟通的效率和自我效能（定性评估）。 步骤：该试点的结果将填补精神护理服务方面的数据空白，并为大规模提供信息 VET-Spirit 混合型 1 有效性实施试验。