Advancing the Conversations Helpful for Awareness of Illness Trajectory (CHAT) Intervention

推进对话有助于提高疾病轨迹 (CHAT) 干预意识

基本信息

  • 批准号:
    10668058
  • 负责人:
  • 金额:
    $ 23.04万
  • 依托单位:
  • 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:
    2023-06-01 至 2025-05-31
  • 项目状态:
    未结题

项目摘要

PROJECT SUMMARY Heart failure with preserved ejection fraction (HFpEF) is a geriatric syndrome that disproportionately impacts older adults and is associated with high symptom burden, reduced quality of life, and a 5-year survival rate less than 50%. Yet, few patients with HFpEF understand the condition, its anticipated trajectory, and/or prognosis. This has several important implications, as our preliminary data show: (1) 33% of patients with a prior hospitalization for HFpEF are unaware that they have a form of heart failure; (2) symptom burden is high and engagement in symptom management is low; and (3) advanced care planning (ACP) is vastly underutilized among this patient population. Symptom management and ACP are key features of palliative care, but palliative care is either utilized at terminal disease stages or not at all. To address the urgent need to improve symptom management and ACP earlier in the disease than has traditionally been done, we developed the Conversations Helpful for Awareness of Illness Trajectory (CHAT) intervention. This intervention is grounded in self-determination theory, which outlines the importance of competence, autonomy, and relatedness in driving behavior change. CHAT will provide knowledge (competence), improve patient activation and self-efficacy (autonomy), and strengthen the patient-physician relationship (relatedness) through a combination of online patient-facing video-based modules using the Patient Activated Learning System (PALS) platform and a health coach who will guide patients through the online modules to promote active engagement. The objectives of this proposal are to: (1) refine the CHAT intervention by incorporating key stakeholders’ feedback through semi- structured qualitative interviews of patients, caregivers, and physicians, and (2) pilot test the CHAT intervention for feasibility, acceptability, and preliminary efficacy through a pilot randomized controlled trial. MPIs Goyal and Shen have complementary areas of expertise in HFpEF, implementation science, communication-based interventions, and social psychological frameworks. The investigator team also includes a primary care physician with expertise in intervention development who also created PALS, a nurse scientist with expertise in heart failure self-care and patient-reported outcomes, and a geriatrician/palliative care specialist with expertise in decision-making in heart failure and implementation science. The long-term objective is to develop a model for communicating illness trajectory to promote proactive patient engagement in managing symptoms (and improve QOL), and engagement in ACP. This proposal seeks to move beyond traditional siloed approaches of care to address the need to “incorporate palliative care approaches for aging-related conditions by healthcare practitioners who are not palliative care specialists.”
项目概要 射血分数保留的心力衰竭 (HFpEF) 是一种老年综合征,对患者的健康造成不成比例的影响 老年人,与高症状负担、生活质量下降和 5 年生存率较低有关 然而,很少有 HFpEF 患者了解其病情、其预期轨迹和/或预后。 正如我们的初步数据所示,这有几个重要的意义:(1) 33% 的患者既往患有 因 HFpEF 住院但不知道自己患有某种形式的心力衰竭;(2) 症状负担重; 症状管理的参与度较低;(3) 高级护理计划 (ACP) 的利用严重不足; 在这一患者群体中,症状管理和 ACP 是姑息治疗的关键特征,但是 姑息治疗要么在疾病末期使用,要么根本不使用,以满足改善的迫切需要。 比传统做法更早地在疾病发生时进行症状管理和 ACP,我们开发了 有助于提高疾病轨迹意识的对话 (CHAT) 干预该干预措施的基础是。 自我决定理论,概述了能力、自主性和相关性在驾驶中的重要性 行为改变将提供知识(能力),提高患者的积极性和自我效能。 (自主性),并通过在线结合加强医患关系(相关性) 使用患者激活学习系统 (PALS) 平台和健康中心的面向患者的基于视频的模块 教练将指导患者完成在线模块以促进积极参与。 建议是:(1)通过半半综合的方式纳入主要利益相关者的反馈,从而完善 CHAT 干预措施。 对患者、护理人员和医生进行结构化定性访谈,以及 (2) 对 CHAT 干预进行试点测试 通过 MPI Goyal 的试点随机对照试验来确定可行性、可接受性和初步疗效。 Shen 在 HFpEF、实施科学、基于通信的专业领域具有互补的专业知识 干预措施和社会心理框架。调查小组还包括初级保健。 拥有干预开发专业知识的医生,他还创建了 PALS,一位拥有以下专业知识的护士科学家 心力衰竭自我护理和患者报告的结果,以及具有专业知识的老年病学家/姑息治疗专家 心力衰竭决策和实施科学的长期目标是开发一个模型。 用于传达疾病轨迹以促进患者主动参与管理症状(以及 提高 QOL),并参与 ACP。该提案旨在超越传统的方法。 护理以满足“将姑息治疗方法纳入医疗保健与衰老相关疾病的需要” 非姑息治疗专家的从业者。”

项目成果

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PARAG GOYAL其他文献

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{{ truncateString('PARAG GOYAL', 18)}}的其他基金

A Novel Deprescribing Intervention for Heart Failure with Preserved Ejection Fraction (HFpEF): A Prototype for Older Adults with Multimorbidity and Polypharmacy
射血分数保留 (HFpEF) 心力衰竭的新型处方干预措施:针对患有多种疾病和多药治疗的老年人的原型
  • 批准号:
    10227996
  • 财政年份:
    2020
  • 资助金额:
    $ 23.04万
  • 项目类别:
A Novel Deprescribing Intervention for Heart Failure with Preserved Ejection Fraction (HFpEF): A Prototype for Older Adults with Multimorbidity and Polypharmacy
射血分数保留 (HFpEF) 心力衰竭的新型处方干预措施:针对患有多种疾病和多药治疗的老年人的原型
  • 批准号:
    10045730
  • 财政年份:
    2020
  • 资助金额:
    $ 23.04万
  • 项目类别:
A Novel Deprescribing Intervention for Heart Failure with Preserved Ejection Fraction (HFpEF): A Prototype for Older Adults with Multimorbidity and Polypharmacy
射血分数保留 (HFpEF) 心力衰竭的新型处方干预措施:针对患有多种疾病和多药治疗的老年人的原型
  • 批准号:
    10433979
  • 财政年份:
    2020
  • 资助金额:
    $ 23.04万
  • 项目类别:
A Novel Deprescribing Intervention for Heart Failure with Preserved Ejection Fraction (HFpEF): A Prototype for Older Adults with Multimorbidity and Polypharmacy
射血分数保留 (HFpEF) 心力衰竭的新型处方干预措施:针对患有多种疾病和多药治疗的老年人的原型
  • 批准号:
    10673696
  • 财政年份:
    2020
  • 资助金额:
    $ 23.04万
  • 项目类别:

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