Evaluating effectiveness of a communication facilitator to reduce distress and improve goal concordant care for critically ill patients and their families

评估沟通促进者在减轻危重患者及其家人的痛苦和改善目标一致护理方面的有效性

• 批准号: 9794765
• 负责人: J Randall Curtis
• 金额: $ 66.01万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-27 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9794765
• 关键词: Accounting; Acute; Address; Anxiety; Behavioral; Caring; Clinical; Communication; Communities; Conflict (Psychology); Confusion; Critical Care; Critical Illness; Distress; Effectiveness; Effectiveness of Interventions; Emotional; Ensure; Family; Family member; Feedback; Future; Goals; Health Care Costs; Healthcare; Home environment; Hospital Costs; Hospitalization; Hybrids; Individual; Intervention; Intervention Trial; Knowledge; Lead; Length of Stay; Life; Long-Term Care; Measures; Mediating; Mediation; Medical; Mental Depression; Methodology; Modeling; Multicenter Trials; Nurses; Outcome; Patient-Focused Outcomes; Patients; Penetration; Physicians; Positioning Attribute; Process; Provider; Qualitative Methods; Quality of life; Quality-of-Life Assessment; Randomized; Resources; Science; Secure; Self Efficacy; Skilled Nursing Facilities; Testing; Time; Training; Work; aging population; attentional control; base; care costs; cost; depressive symptoms; expectation; experience; high risk; hospital readmission; implementation trial; improved; improved outcome; innovation; intervention cost; novel; phase 2 study; phase II trial; post-traumatic stress; primary outcome; psychological distress; randomized trial; reduce symptoms; skills; social cognitive theory; theories

PROJECT SUMMARY The impact of critical illness is increasing due to our aging population as well as advances in effectiveness and availability of critical care. Critically ill patients and their families suffer a high burden of symptoms of depression, anxiety, and post-traumatic stress due, in part, to fragmented medical care that is often poorly aligned with their goals. Fragmented care includes numerous transitions for patients and families across clinicians and across settings, starting in the ICU and extending to acute care, skilled nursing facilities, or home. As illness progresses, patients and families struggle to navigate the spectrum of goals of care, to match their values and goals with treatments, to communicate their goals to their clinicians, and to make difficult medical decisions without letting unmet emotional needs interfere. Poor communication exacerbated by these transitions compounds an already stressful experience, causing distress to patients and their families. Taken together, these issues lead to ineffective communication during and after the ICU which can often result in high intensity “default” care that may be unwanted. Using a randomized trial, this application proposes to evaluate an innovative model of care in which ICU nurse facilitators support, model, and teach communication strategies that enable patients and families to secure care in line with their goals over an illness trajectory, beginning in the ICU and continuing into the community. Facilitators will use communication skills, attachment theory, and mediation to improve: 1) patients' and families' self-efficacy to communicate with clinicians within and across settings; 2) patients' and families' outcome expectation that communication with clinicians can improve their care; and 3) patients' and families' behavioral capability through skill building to resolve barriers to effective communication and mediate conflict. Facilitators will work with seriously ill patients (n=376) and their families (n=564) beginning with a critical care unit stay and following them over the course of 3 months. The intervention's effectiveness will be measured with patient- and family-centered outcomes including symptoms of depression, anxiety, and post-traumatic stress, as well as quality of life and assessments of goal- concordant care, at 1, 3, and 6 months post-randomization. The primary outcome will be family members' burden of symptoms of depression over the 6 months. We will also evaluate whether the intervention improves the value of healthcare by reducing healthcare costs while improving patient and family outcomes. Finally, we will use qualitative methods to explore implementation factors (intervention, settings, individuals, processes) associated with improved implementation outcomes (acceptability, fidelity, penetration) to inform dissemination of this type of intervention to support patients and their families. This application will address key knowledge gaps while evaluating a methodologically rigorous intervention to improve outcomes for patients with serious illness and their families across the trajectory of care and the spectrum of goals of care.

项目摘要 由于我们的人口老龄化以及有效性和有效性的进步，重症疾病的影响正在增加 重症监护的可用性。重病患者及其家人的症状高度燃烧 抑郁症，焦虑和创伤后压力部分是由于碎裂的医疗保健通常很差 与他们的目标保持一致。零散的护理包括许多针对各个患者和家庭的转变 临床医生和整个环境，从ICU开始，延伸到急诊护理，熟练的护士设施或 家。随着疾病的进展，患者和家庭难以导航护理目标，以匹配 他们通过治疗的价值观和目标，将目标传达给临床医生，并使其困难 医疗决策，而无需让未满足的情绪需求干扰。沟通不佳，这些沟通加剧了这些 过渡使已经压力很大的经历使患者及其家人造成困扰。拍摄 这些问题一起导致ICU期间和之后的沟通无效，这通常会导致高 强度“默认”护理可能是不必要的。使用随机试验，该申请提案评估 ICU护士促进者支持，模型和教学沟通的创新护理模型 使患者和家庭能够按照疾病轨迹的目标确保护理的策略， 从ICU开始，继续进入社区。主持人将使用沟通技巧，依恋 理论和改进的调解：1）与临床医生在内部与临床医生沟通的患者和家庭 以及跨环境； 2）患者与临床医生的沟通可以达到的结果期望 改善他们的护理； 3）通过技能建设来解决障碍的患者和家庭的行为能力 有效的沟通和媒体冲突。促进者将与重病患者（n = 376）和 他们的家人（n = 564）从重症监护病房开始并在3个月的时间内关注他们。 干预措施的有效性将以患者和家庭为中心的结果来衡量 抑郁症，焦虑和创伤后压力的症状，以及生活质量和目标评估 随机化后1、3和6个月，一致的护理。主要结果将是家庭成员 在6个月内抑郁症状的负担。我们还将评估干预是否有所改善 通过降低医疗保健成本，同时改善患者和家庭成果，医疗保健的价值。最后，我们 将使用定性方法来探索实施因素（干预，设置，个人，流程） 与改善的实施成果（可接受性，忠诚，渗透率）相关联 这类干预措施以支持患者及其家人。该应用程序将解决关键知识 差距在评估方法论严格的干预措施中，以改善严重患者的预后 疾病及其家人跨越护理轨迹和护理目标。