Randomized Trial of Specialty Palliative Care Integrated with Critical Care for Clinically Ill Older Adults at High Risk of Death or Severe Disability - Supplement

针对死亡或严重残疾高风险的临床疾病老年人的专业姑息治疗与重症监护相结合的随机试验 - 补充

• 批准号: 10714105
• 负责人: Yael Schenker
• 金额: $ 39.45万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10714105
• 关键词: Academy; Acute; Administrative Supplement; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Area; Caregiver support; Caregivers; Caring; Communication; Complex; Critical Care; Critical Illness; Data; Elderly; Enhancement Technology; Family; Family Caregiver; Goals; Group Processes; Health; Hospitalization; Hospitals; Intervention; Light; Medicine; Methods; Outcome; Palliative Care; Parents; Patient Care; Patient Preferences; Patient-Centered Care; Patients; Physicians; Provider; Quality of Care; Research Personnel; Signal Transduction; Specialist; Technology; Training Programs; Treatment Efficacy; Work; arm; clinical care; disability; efficacy evaluation; end of life; evidence base; functional decline; high risk; hospital readmission; improved; innovation; medical specialties; mortality risk; older patient; patient engagement; pilot trial; programs; randomized trial; skill acquisition; skills; usability

ABSTRACT The National Academy of Medicine has identified improving clinicians’ serious illness communication skills (SICS) as a priority area to improve patient and family outcomes near the end of life. SICS are particularly important for hospitalized patients with moderate-to-severe Alzheimer’s disease or related dementias (ADRD) because: 1) patients’ preferences vary substantially regarding goals of care in this context; and 2) hospitalization often signals a worsening health trajectory with cascading readmissions and functional decline, and therefore presents an opportunity to engage in robust goals of care conversations. However, a critical barrier to achieving widespread improvements in this aspect of care for hospitalized ADRD patients is the absence of a scalable, empirically-validated way to help clinicians acquire the complex communication skills needed to engage patients and families in goals of care discussions in the hospital setting. The parent R01 on which this supplement builds is an RCT among critically ill older patients assessing the efficacy of an intervention involving goals-of-care conversations delivered by palliative care (PC) specialists to improve patient and family caregiver outcomes. The broad focus of both the parent R01 and this ADRD supplement is on caregiver support and patient-centered care through enhanced clinician-patient-caregiver communication. In light of the workforce shortages for PC specialists, improving the skills of non-PC specialists, which is the goal of the supplement proposal, is a critical strategy to increase care quality for hospitalized ADRD patients. Our goal is to create and disseminate a technology-enhanced intervention that is both scalable and empirically-validated to help hospital-based physicians and advanced practice providers (APPs) acquire the skills needed to effectively conduct goals-of-care conversations for hospitalized patients with ADRD and their families. Therefore, in Aim 1, we will use a nominal group process to engage a diverse stakeholder panel in the construction of the technology-enhanced SICS intervention for clinicians treating patients with ADRD. In Aim 2, we will conduct a single-arm pilot trial to evaluate the feasibility, acceptability, and efficacy (i.e., skills acquisition) of the SICS intervention. The proposed work will have high impact because it will yield the preliminary data needed for a successful R01 application to conduct an RCT to determine the impact of the scalable SICS intervention on the outcomes of hospitalized patients with ADRD and their caregivers. The project is innovative because it seeks to develop the first empirically-validated SICS intervention for clinicians of patients with ADRD that leverages technology to achieve high scalability. The work is feasible in our hands because we are a team of established investigators with a strong commitment to improving patient and caregiver outcomes in ADRD.

抽象的 美国国家医学院已确定“改善”严重疾病 沟通技巧（SICS）作为接近尾声改善患者和家庭结果的优先领域 SICS 对于患有中度至重度阿尔茨海默病的住院患者尤其重要。 疾病或相关痴呆症 (ADRD)，因为：1) 患者对于以下方面的偏好差异很大： 在此背景下的护理目标；2) 住院通常预示着健康状况恶化 级联再入院和功能衰退，因此提供了参与的机会 然而，实现广泛的护理对话的一个关键障碍。 对住院 ADRD 患者的护理在这方面的改进是缺乏可扩展的、 经过经验验证的方法，可帮助您获得所需的复杂沟通技能 让患者和家属参与医院环境中的护理讨论目标。 该补充剂所基于的母版 R01 是一项针对老年危重患者的随机对照试验 评估涉及姑息治疗提供的护理目标对话的干预措施的有效性 护理（PC）专家改善患者和家庭护理人员的结果是双方的广泛关注点。 父母 R01 和此 ADRD 补充剂通过以下方式提供护理人员支持和以患者为中心的护理 鉴于 PC 劳动力短缺，加强了临床医生、患者和护理人员之间的沟通。 专家，提高非 PC 专家的技能，这是补充提案的目标， 是提高住院 ADRD 患者护理质量的关键策略。 我们的目标是创建并传播一种技术增强的干预措施， 可扩展且经过经验验证，可帮助医院医生和先进实践 提供者（APP）获得有效开展护理目标对话所需的技能 因此，在目标 1 中，我们将使用名义组。 让多元化利益相关者小组参与技术增强型 SICS 建设的流程 在目标 2 中，我们将进行单臂试点。 评估 SICS 的可行性、可接受性和有效性（即技能获取）的试验 干涉。 拟议的工作将产生重大影响，因为它将产生所需的初步数据 为成功的 R01 应用程序进行 RCT 以确定可扩展 SICS 的影响 对住院 ADRD 患者及其护理人员的结果进行干预 该项目是。 创新是因为它旨在为居民开发第一个经过经验验证的 SICS 干预措施 ADRD 患者利用技术实现高可扩展性这项工作是可行的。 我们的双手，因为我们是一支由成熟的调查人员组成的团队，坚定地致力于 改善 ADRD 患者和护理人员的治疗效果。